Marcelo Di Gregorio
Metastasis to the penis from a bladder carcinoma invading only the lamina propria: case report. Review of the literature and description of the metastatic pathways. Authors: Marius Stanimir, Marcelo Di Gregorio, Francis Lorge, Marie-Cécile Nollevaux, Lionel D'Hondt Keywords: Penile metastasis, Cystoprostatectomy, Total penectomy, Immunotherapy Topic Case report Abstract / Case report Introduction: Penile cancer is uncommon in industrialized countries with a low incidence of the disease of about 1/100.000 men in Europe and USA. Despite its rich venous and lymphatic vascularization, secondary metastasis to the penis are rare. Case presentation: We present the case of a 70 years old male, who was initially referred for gross hematuria in May 2018. After meticulous anamnesis, a cystoscopy was performed under local anesthesia, which detected a bladder lesion situated at the dome of the bladder that seemed to be muscular invasive bladder tumor. The histological exam after a transurethral resection of the tumor, revealed an invasive high-grade papillary transitional carcinoma of the bladder with lamina propria invasion (pT1 HG). The second-look transurethral resection was performed at the site of the anterior resection and the histological examination of the tissue revealed the same high-grade papillary transitional carcinoma of the bladder with lamina propria invasion but no muscular invasion (pT1 HG). During the follow-up, a thoraco-abdominal CT scan was performed and a nodule in the upper right lobe of the lung was discovered which was resected (lung acinar adenocarcinoma - pT1cN0). At 7 months from the diagnosis, an abdominal CT scan was performed finding a tumor at the anterior bladder wall measured at about 78x77x78 mm and staging of cT4. Following these findings, a MVAC chemotherapy (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) was admistrated and a cystoprostatectomy was performed with an histological result of fibrosis and ypT0pN0 classification. About eight months after the cystoprostatectomy, the patient complained of having pain and swelling of the right side cavernous body. An MRI of the pelvis was performed and a lesion of about 30x20x20 mm was observed at the base of the penis. A total penectomy with perineal urethrostomy was performed and the result of the histological examination of the tumor revealed a transitional carcinoma suggesting a metastasis of the urothelial carcinoma of the bladder, pM1bR2. A PET/CT had been performed 3 months after the penectomy and it showed multiple retroperitoneal, right external iliac and bilateral inguinal positives lymph nodes. Metastasis of the obturator foramen and of the right peritoneal flank were also observed. Giving the mentioned results of the PET/CT, we started a treatment based on Pembrolizumab. At the time of publishing, the patient is following the immunotherapy treatment and he has no progression of the disease. Conclusion: Although the metastasis to the penis is a rare condition, the differential diagnosis is essential for deciding on the right treatment for the patient. Even though most of the patients could benefit from a multi modal treatment, the overall survival period for most of the patients is about 9 months after the diagnosis of the penile metastasis.
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