Penile Metastasis Secondary to Bladder Cancer: A Report of Two Cases
A 58-year-old male presented with hematuria for 1 month. He smoked one pack of cigarettes per day for last 30 years. He was thoroughly investigated and CECT scan revealed a soft tissue density mass in posterior wall of urinary bladder. He underwent transurethral resection of bladder tumor and histopathology showed high grade urothelial carcinoma with involvement of deep muscle. He received four cycles of neoadjuvant chemotherapy based on injection cisplatin 70 mg/m2 intravenous day 1 and injection gemcitabine 1.2 g/m2 day 1 and day 15. After four cycles of neoadjuvant chemotherapy, he underwent radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion. Patient was kept on follow-up and after 4 months of surgery patient complained of painful swelling on glans penis. Clinical examination revealed indurated swelling at base of penis and another small nodule present at the shaft of the penis. MRI pelvis showed evidence of well-defined heterogeneous soft tissue mass of size 5 × 2.8 × 2 cm seen in left crura of the penis near its base. It was hyperintense on T2W1 and isointense on T1W1and it showed thick irregular peripheral enhancement []. Similar lobulated soft tissue lesion of size 1.8 × 1.9 × 1 cm was seen just medial to right puborectalis muscle. FNAC of penile lesion revealed metastatic carcinoma []. Positron emission tomography scan showed intensely fluorodeoxyglucose (FDG) avid Standardized uptake value (SUV) maximum 17.6) heterogeneously enhancing soft tissue mass seen in the proximal two-third of the shaft of the penis extending to left crura with intensely FDG avid well-defined nodules of variable sizes were noted in bilateral lung fields [Figures and ]. He received palliative external beam radiotherapy to pelvis 20 Gy in five fractions delivered over a period of 1 week and he was registered in our palliative clinic. He did not receive any further chemotherapy in view of poor general condition and was expired within 2 months.