(388) Primary Penile Squamouse Cell Cancer Related Malignant Priapism In A Cystectomized Patient: A Case Report

Abstract

Abstract Introduction Priapism is a prolonged (> 4 hours) and unintended erection without sexual stimulation or sexual desire. Priapism due to neoplasms is called malignant priapism, which is a rare condition that tends to occur with corporeal metastasis of other pelvic area malignancies. Priapism due to primary penile malignancies is extremely rare. Objective In this article, we present the case of a patient who underwent total penectomy and bilateral inguinal lymphadenectomy due to malignant priapism related to primary penile squamous cell cancer (SCC), and who also underwent radical cystectomy (RC) and total urethrectomy due to urothelial carcinoma 19 and 2 years prior, respectively. Methods We prepared the patient's information to present. Results An 82-year-old male patient presented to an outpatient clinic with unintended erection and penile pain of about 48 hours’ duration and was on follow-up in our clinic because of urothelial carcinoma history. The patient’s history indicated that he underwent RC and orthotopic neobladder due to muscle-invasive urothelial cancer (UC) in the bladder. No tumor was observed in the final cystectomy pathology; therefore, no adjuvant therapy was given. Seventeen years after the RC operation, he presented with hematuria and a papillary lesion detected in the mid-urethra during cystourethroscopy. Since the biopsy result from this region was compatible with high-grade UC, he underwent total urethrectomy, neobladder resection, and ileal conduit. Urethrectomy pathology results were reported as UC invading the subepithelial stroma and lymphovascular area. Adjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy was administered. On follow-up 2 years after the urethrectomy operation, he presented with prolonged priapism. On examination, a cold and erect penis with a 1 cm diameter ulcerated lesion on the glans penis were observed. Hypoxia and hypercarbia were observed on the cavernosal blood gas examination, which was compatible with ischemic priapism. The hemogram was normal. On the emergent penile duplex Doppler ultrasound showed decreased blood flow and a mass on the proximal part of the penis. Subsequently, pelvic magnetic resonance imaging was performed and a mass was observed that was fully destructive to the cavernosal bodies and had irregularly circumscribed borders (Figure 1). Afterward, the patient underwent a total penectomy and bilateral inguinal lymphadenectomy. The pathology report from the penectomy material suggested that the tumor was compatible with moderately differentiated SCC. No sign of metastasis was observed in the lymph nodes. Extensive sampling of the tumor did not reveal any UC in situ, nor SCC in situ. The penis shaft was fully infiltrated by the tumor, with SCC morphology starting from the surgical margin and damaging all the structures of the penile body (Figure 2). The patient was transferred to the oncology clinic for additional treatment planning. Conclusions Despite being the most common primary malignancy of the penis, to the best of our knowledge priapism due to primary penile SCC has been reported only once in the literature. Although metastatic disease is typically thought to be the cause, when a patient with a history of pelvic malignancy presents with malignant priapism, it should be kept in mind that primary malignancies of the penis may also cause this condition. Disclosure No