Metastasis to the Glans Penis from a Rectal Adenocarcinoma, Diagnosed Two Years After Radical Treatment for Primary Therapy.66 a of Case Literature

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Recebido: 28de Agosto de2014- Aceite: 01deJunho2015 |  3. Serviçode Anatomia Patológica.HospitaldeSantaMaria.CentroHospitalarLisboa Norte.Lisboa.Portugal. 2. ServiçodeOncologiaMédica.Hospital SantaMaria.CentroHospitalarLisboaNorte.Lisboa.Portugal. 1. ServiçodeRadioterapia.HospitalSanta Maria.CentroHospitalarLisboaNorte.Lisboa.Portugal. glans penis(pretreatment) the of half right the occupying consistency hard and surface gular 1 Figure RESUMO Acta MedPort2015Jul-Aug;28(4):xxx-xxx Beatriz NUNES ABSTRACT even thoughnopathognomonicclinicalfeaturesexist. retention and hematuria are frequent presenting symptoms, bladder) aretheprimarysitesoforigin. and (prostate organs genito-urinary cases, the of 64% In literature. in reported cases 400 than less with condition, Carcinoma doRecto Metástase daGlandePeniana:UmaLocalizaçãoInvulgarparaRecorrênciade of RectalCancerRecurrence Metastasis totheGlansPenis: An UnusualSite BACKGROUND A Autor correspondente:[email protected] Palavras-chave: neoplasia do recto é mandatório. A radio-quimioterapia é uma abordagem válida, com bom controlo da doença e melhoria sintomática. radio-quimioterapia e permanece assintomático e livre de doença após um ano de seguimento. O com paliativo tratamento a submetido foi doente O primária. doença da tratamento o após anos dois diagnosticada recto, do cinoma adenocar de contexto em peniana glande da metástase com anos 66 de doente um de caso o documentam autores Os restantes. radioterapia; local; excisão penectomia; incluem: tratamento quimioterapia; terapêuticade suporte. Apesar das várias terapêuticas existentes, nenhuma na literatura é apontada como superior às de opções as e mau é prognóstico O genito-urinários. órgãos os são A doença secundária do pénis é uma situação clínica frequentemente associada a doença disseminada e as localizações mais comuns Keywords: and effective therapeuticoptionforpenilemetastasis, addressingbothdiseasecontrolandsymptomaticimprovement. one year follow-up. Close follow-up of patients with history of rectal adenocarcinoma is very important. Radiochemotherapy is a feasible disease. The patient underwent palliative treatment with radiotherapy and chemotherapy, remaining asymptomatic and disease-free at year-old man with a metastasis to the glans penis from a rectal adenocarcinoma, diagnosed two years after radical treatment for primary therapy.66 a of case literature. the the report in authors outcomes The treatment superior to lead options therapeutic these of Neither The malignancies. genitourinary prognosis disseminated is poor with and the treatment associated options include often penectomy, condition, local surgical clinical excision, radiation rare therapy, a chemotherapy and is supportive penis the of malignancy Secondary h mtsai ivleet f h pns s rare a is penis the of involvement metastatic The The authors present a case of metastasis to the glans the to metastasis of case a present authors The urinary pain, penile priapism, mass, or nodule penile A – Erythematous ill-defined infiltrating plaque with an irre an with plaque infiltrating ill-defined Erythematous – NeoplasmMetastasis;PenileNeoplasms/secondary;Radiotherapy;RectalNeoplasms.  Metastases;NeoplasiasdoPénis/secundária;Recto;Radioterapia. 1 , MargaridaMATIAS ica da Ordem dos Médicos www m o c . a s e u g u t r o p a c i d e m a t c a w. w w s o c i d é M s o d m e d r O a d a c fi í t n e i C a t s i v e R B 2 2

1 invasive adenocarcinoma( 2 Figure moderately a revealed biopsy histologic tumor and the rectum of distal evaluation the of lesion ulcerated an showed Colonoscopy months). 7 in kg (7 loss weigh and prostatic hypertrophy presented with diarrhea, rectorrhagia, consumption (40 pack-year), total prostatectomy for benign CASE PRESENTATION years afterabdominoperinealresection. 2 diagnosed adenocarcinoma, rectal a to secondary penis 6-erod a wt a esnl itr o tobacco of history personal a with man 63-year-old A HE Hsooia scin f h gas ei showing penis glans the of section Histological H&E, – 1 A -40x; follow-up B A –100x) apertado dos doentes com B -

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) B C ) and CDX2 ( CDX2 and ) A 2 B and TTF1. and Acta Med Port 2015 Jul-Aug;28(4):xxx-xxx Jul-Aug;28(4):xxx-xxx Port 2015 Acta Med Chest, abdominal and pelvic post-treatment reevaluation post-treatment pelvic and abdominal Chest, In spite of the rich vascularization and extensive been have penis the to metastases of pathways Various The patient underwent 3D conformal external CT scans were follow-up (Fig. 5). asymptomatic and disease-free at 1 year unremarkable. The patient remains DISCUSSION communication between the penis and organs, penile metastatic lesions are rare. the neighboring suggested: retrograde venous route, retrograde lymphatic immunohistochemistry immunohistochemistry confirmed the clinical hypothesis of a metastasis to the glans penis of an adenocarcinoma with 2 and 3). colorectal origin (Fig.s radiotherapy of the penile lesion (total dose of 30 Gy in 10 fractions, one direct field technique with electrons) (Fig. 4) with concomitant capecitabine (825 mg/m2, twice a 5 day, days/week). There were no reported complete response of penile lesion occurred. side effects and 2 A ). The complete immunohistochemical study showed positivity for AE1/AE3, cytokeratins CK20, CDX2, C Neoadjuvant treatment with 3D with treatment Neoadjuvant 5 , twice a day, 5 days/week, was R e v i s ta C i e n tífi c a d a Or d e m d o s M é d i c o s w w w.a c ta m e d i c a p o r tu g u e s a .c o m 2 Nunes B, et al. Metastasis to the glans penis: unusual site of recurrence, of recurrence, unusual site glans penis: to the B, et al. Metastasis Nunes – Immunohistochemical staining of the metastatic adenocarcinoma showing immunoreactivity to cytokeratin 20 ( 20 cytokeratin to immunoreactivity showing adenocarcinoma metastatic the of staining Immunohistochemical – – Map of calculated doses for a 3D conformal external treatment (one direct field technique with electrons) and 3D reconstructions 3D and electrons) with technique field direct (one treatment external conformal 3D a for doses calculated of Map – A skin A lesion on the glans was noted on January 2013, an irregular surface and hard consistency occupying the right half of the glans was observed (Fig. 1). Histology and bleeding. spontaneous and growth progressive with evolving with plaque infiltrating ill-defined erythematous an Clinically, pathological examination was consistent There were several post-operative complications, including with ypT3N1. surgical repair of a prostatic-cutaneous fistula. No adjuvant chemotherapy was performed. capecitabine (850 mg/m performed from July to August the 2011. In patient October underwent 2011, abdominoperineal resection and Malignant Tumours (TNM). Tumours Malignant conformal external radiotherapy (pelvic total dose of 50.4 Gy in 28 fractions, four-field technique) and concomitant computed tomography (CT) and pelvic magnetic resonance magnetic pelvic and (CT) tomography computed imaging (MRI), the rectal as adenocarcinoma a was cT3N+M0, according staged to the TNM Classification of and negativity to cytokeratin 7 ( 34βE12, PSA antigen and negativity for CK7, villin, β-catenin and carcinoembryonic differentiated adenocarcinoma. After abdominopelvic Figure 3 Figure Figure 4 Figure

CASO CLÍNICO 5. 4. 3. 2. 1. REFERENCES disease metastatic the for methods noninvasive useful are Ultrasonography, CT, MRI and required. positron is examination emission pathological tomography for biopsy aspiration diseases. inflammatory other and tuberculosis disease, Peyronie’s syphilis, primary chancre, chancroid, cancer,condylomata acuminata, non-tumorous priapism, penile primary from also is priapism pointed asaprominentfeature. patients, of 40% in penis; of induration external adjuvant and radiation therapy. excision surgical with one, other the in and, brachytherapy rate dose low with treated was penis glans the to cancer metastasis the case, one their in – diagnosis after years nine over Abeshouse surviving patients 1961, two In cases. poor survival a long predicts generally prognosis. and disease disseminated locations arerectum,kidney, colonandtestes. primary Other sites. primary common most the as bladder since. ever malignancy in 1870 and almost 400 cases were documented malignant cells, is considered the most likely mechanism. of the penis, which provides routes for easy transportation of the pudendal venous system onto the dorsal venous system from flow venous Retrograde instrumentation. surgical and extension direct extension, arterial spread, arterial route, of disease Figure 5 A

Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A editors. TrottiA FL, Greene AG, Fritz CC, Compton DR, Byrd S, Edge Cancer. Colorectal Clin adenocarcinoma. 2007;6:657-9. rectal a from penis the to Ketata S, Boulaire J, Soulimane B, Assoc. 1980;72:55-8. Med Natl J penis. the of carcinoma Metastatic JR. P,Newland Kumar penile tumorsrevisited.IntSeminSurgOncol.2006;3:33. A, Thwaini S, Rajan J, Cherian Clin ImagingSci.2012;2:44. J report. case a increase: level PSA without adenocarcinoma prostatic Pierro A, Cilla S, Digesù C, Morganti AG. o te xc danss a icsoa o fine-needle or incisional an diagnosis, exact the For differentiated be should metastasis penile suspected A or nodule/mass a with clinically present cases Most with associated usually is involvement Penile penile of secondary case first the reported Eberth – Glans penis six months after treatment, with no evidence 2,7 7,8 1 New data have recently revealed prostate and prostate revealed recently have data New eetees sm atos ae reported have authors some Nevertheless, Nunes B,etal.Metastasistotheglanspenis:unusualsiteofrecurrence, ica da Ordem dos Médicos www m o c . a s e u g u t r o p a c i d e m a t c a w. w w s o c i d é M s o d m e d r O a d a c fi í t n e i C a t s i v e R Elmasry Y Elmasry Bargain Bargain A B 2

Penile metastases of recurrence , Shah T Shah . Metachronous metastasis , 9 Puri R Puri documented 2 . Secondary . 2,6 3 PROTECTION OF HUMANS ANDANIMALS OF PROTECTION avoiding moreaggressivesurgicalapproaches. origin, colorectal of metastasis penile for option therapeutic histological diagnosis in infrequentrecurrencelocationsliketheglanspenis. crucial. infrequent primarysource. TAKE HOME MESSAGES the literature. these in outcomes treatment superior to therapy,lead of options therapeutic Neither therapy. radiation include supportive excision, and options chemotherapy surgical Treatment local intention. penectomy, palliative a has performance status and primary cancer stage, but frequently evaluation andrestaging. 9. 8. 7. 6. FUNDING SOURCES interest. CONFLICTS OFINTEREST data patient’s regarding center publication. working their at use in DATA CONFIDENTIALITY Declaration oftheWorld Medical Association. the by Clinical established Research and Ethics Committee and to the Helsinki regulations the followed described procedures the that and Hospital the of Committee Ethics

bsos B, bsos G. eattc uor o te ei: A penis: the of review of the literature tumours and a report of two Metastatic cases. J Urol.1961;86:99-122. GA. Abeshouse BS, S. Abeshouse Inoue M, pelvic Warabi total exenteration. World JGastroenterol.2012;18:5476-8. after H, cancer rectal Matsunaga from metastasis K, penile Nasu Metachronous D, Shida penile Y, to Kimura secondary Priapism SY. Park MK, metastasis ofrectalcancer. World JGastroenterol.2009;15:4209-11. Kang W, Lee J, Park 3. penile metastasis from the rectal carcinoma. Radiol Oncol. 2010;44:121- Yildirim M, Coskun A, Pürten M, AJCC CancerStagingManual.7 - exact the on depends treatment appropriate The - especially mandatory, is lesions suspicious of Biopsy - is patients cancer colorectal of follow-up close A - - Penile metastases are rare, and colorectal cancer is an the by influenced greatly is treatment of choice The No The The The aiceohrp i a esbe n effective and feasible a is Radiochemotherapy subsidies authors authors authors Acta MedPort2015Jul-Aug;28(4):xxx-xxx 4 declare that the study was approved by the elr ta te floe te protocols the followed they that declare declare that there are no conflicts of conflicts no are there that declare orgrantscontributedtothiswork. 6 Oztekin O Th ed.Chicago:Springer-Verlag; 2010. , Ilhan E . A clinical case of the

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