although a richly vascularized organ with important circulatory communications , the penis is seldom the site of metastases . since eberth first reported it in 1870 there have been approximately 300 cases in the english language literature . the primary tumour sites are principally the genitourinary organs , mainly the bladder and prostate gland . only in 15.7% metastatic disease isolated to the penis and amenable to potentially curative treatment is very uncommon [ 13 ] . this is the first case of isolated penile metastasis following abdominoperineal resection ( aper ) with perineal vertical rectus abdominis myocutaneous ( vram ) flap reconstruction . a 58-year - old gentleman presented with diarrhoea . digital rectal examination revealed a low anterior rectal tumour , 3 cm from the anal verge . due to his frequency he underwent laparoscopic defunctioning colostomy prior to neoadjuvant long course chemoradiation in the aristotle trial . restaging showed a modest response to treatment with the crm still predicted positive ( figs 1 and 2 ) . at 9 weeks post radiotherapy he underwent an open difficult aper t2 waited axial image through lower pelvis through the large polypoid rectal tumour with t3 extension involving the crm . t2 axial image through pelvis demonstrating limited response to chemoradiotherapy with tumoral margins still predicted positive . mri pelvis . t2 waited axial image through lower pelvis through the large polypoid rectal tumour with t3 extension involving the crm . t2 axial image through pelvis demonstrating limited response to chemoradiotherapy with tumoral margins still predicted positive . at 18 months post - surgery he presented with an otherwise asymptomatic mass on the lateral aspect of his penile shaft . restaging with ct and mri confirmed an isolated 2.7 cm  6.2 cm lesion in the midshaft involving the corpora cavernosum with extension into the corpus spongiosum . histopathology confirmed metastatic rectal adenocarcinoma with clear resection margins though extensive lympho - vascular and perineural involvement . currently , the patient is clinically doing well , with a reasonable quality of life with his urethrostomy and under close clinical follow up . figure 3:mri pelvis large field t2 sagittal image through penile shaft showing the lesion involving the corpora cavernosum with extension in the spongiosum . mri pelvis large field t2 sagittal image through penile shaft showing the lesion involving the corpora cavernosum with extension in the spongiosum . it is still a controversial subject the reason why the penis , despite its vascularization is a rare site for metastasis . it has been postulated that the route of metastasis include retrograde venous or lymphatic spread , local direct extension , arterial embolism or instrumental spread [ 1 , 2 , 4 ] . currently the most accepted theory is the mechanism that involves retrograde venous spread from pudendal to the dorsal venous system of the penis [ 2 , 4 ] . the most common type of presentation is malignant priapism followed by urinary retention , penile nodules , ulceration , perineal pain , oedema , infiltrative enlargement , dysuria and haematuria , with the corpora cavernosa being the most common site of metastasis and the glans and corpus spongiosum infrequently involved . our case respected the above mentioned cavernosal involvement but also had mild extension into the corpus spongiosum , more to the fact that this isolated metastatic penile neoplasm is extremely rare . management of penile metastasis is mainly palliative   as this is a sign of poor prognosis and tends to be part of widely disseminated disease . treatment plan is influenced by the size of the primary , extent of the metastatic spread , performance status of patient and also prognostic characteristics of the primary tumour [ 2 , 5 ] . treatment modalities include the combination of radiotherapy with chemotherapy , local excision and penectomy [ 2 , 4 ] . in isolated disease , as described in this case , penectomy may offer the possibility of cure although such cases are very rare . in conclusion , this is a case report of penile metastasis following rectal adenocarcinoma , being the first one described in a patient that had aper with vram flap reconstruction . this report highlights the rarity of the penis as site of metastasis and marker of disseminated disease , however this is not the case in our report and albeit rare , cure can be achieved in isolated cases .