Pulmonary Adenocarcinoma Presenting With Penile Metastasis
Pulmonary Adenocarcinoma Presenting With Penile Metastasis
Introduction: Penile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported.
Case presentation: We report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment.
Conclusions: Although these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.
Metastatic neoplasms of the penis are extremely rare. To the best of our knowledge, about 300 have been reported worldwide. They are associated with advanced disease and poor prognosis, regardless of the tumor origin. When metastatic neoplasms do occur, the primary sites are the urinary bladder (in 30% to 35% of cases), the prostate (in 28% to 30%), the rectosigmoid colon (in 13%), the kidneys (in 8% to 10%), and the testes (in 5%). In the remaining cases, the primary tumor is in the gastrointestinal or respiratory tract. When the latter is involved, lung cancer is the leading cause, and among the various histotypes, the vast majority are due to squamous cell carcinoma (SCC). In this paper, we report a rarer case of lung adenocarcinoma that spread to the penis. Also, we perform a review of all similar cases that have been reported in the literature.
In a search of the MEDLINE database for reports of lung cancer that metastasized to the penis, we retrieved 24 cases, the vast majority being SCCs. Among these cases were two cases of adenocarcinoma, one of epidermoid carcinoma, one of large cell carcinoma, one of epithelial carcinoma, and one of small cell carcinoma. The reason that SCC is the primary histological pattern in most cases is unclear, but the fact that adenocarcinoma is a rare occurrence probably relates to its predominance in women. The first reported case of penile metastasis independent of origin was published by Eberth in 1870.
Abstract and Introduction
Abstract
Introduction: Penile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported.
Case presentation: We report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment.
Conclusions: Although these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.
Introduction
Metastatic neoplasms of the penis are extremely rare. To the best of our knowledge, about 300 have been reported worldwide. They are associated with advanced disease and poor prognosis, regardless of the tumor origin. When metastatic neoplasms do occur, the primary sites are the urinary bladder (in 30% to 35% of cases), the prostate (in 28% to 30%), the rectosigmoid colon (in 13%), the kidneys (in 8% to 10%), and the testes (in 5%). In the remaining cases, the primary tumor is in the gastrointestinal or respiratory tract. When the latter is involved, lung cancer is the leading cause, and among the various histotypes, the vast majority are due to squamous cell carcinoma (SCC). In this paper, we report a rarer case of lung adenocarcinoma that spread to the penis. Also, we perform a review of all similar cases that have been reported in the literature.
In a search of the MEDLINE database for reports of lung cancer that metastasized to the penis, we retrieved 24 cases, the vast majority being SCCs. Among these cases were two cases of adenocarcinoma, one of epidermoid carcinoma, one of large cell carcinoma, one of epithelial carcinoma, and one of small cell carcinoma. The reason that SCC is the primary histological pattern in most cases is unclear, but the fact that adenocarcinoma is a rare occurrence probably relates to its predominance in women. The first reported case of penile metastasis independent of origin was published by Eberth in 1870.