Penile Metastasis Secondary to Bladder Cancer: A Report of Two Cases
An 85-year-old male, smoker presented with painless gross hematuria for last 1 year. His routine blood investigations and chest X-ray were within normal limit. Contrast-enhanced computed tomography (CECT) scan showed polypoidal mass in the right posterolateral wall of urinary bladder with bilateral pelvic lymphadenopathy. His metastatic work up (including chest X-ray, CECT chest, abdomen and pelvis, and bone scan) was normal. Patient underwent transurethral resection of bladder tumor and postoperative histopathology revealed a high grade papillary urothelial carcinoma infiltrating the lamina propria and deep muscle. In view of old age and poor general condition of the patient, he was not taken up for radical cystectomy or concurrent chemoradiation. He was planned for radical radiotherapy alone 50 Gy in 25 fractions over 5 weeks with conventional four field technique in 6 MV linear accelerator. After nine fractions, of radiation patient complained of swelling and pain in his penis. Clinical examination revealed a 3 × 2 cm indurated swelling in the shaft of the penis. Magnetic resonance imaging (MRI) showed an ill-defined area of altered signal intensity appearing isointense to muscle on T1 and of intermediate signal intensity on T2-weighed images is seen involving bilateral corpora cavernosa with probable extension to the corpus spongiosum as well []. Fine needle aspiration cytology (FNAC) of the penile swelling revealed metastatic transitional cell carcinoma []. After nine fractions, radiotherapy plan was revised and radiation field was enlarged along with special wax bolus to accommodate the penile lesion. He completed radical radiation uneventfully and was kept on follow-up. No chemotherapy was offered because of old age and poor general condition of the patient. After 2 months of follow-up, he underwent MRI pelvis and both the bladder as well as penile lesion showed partial response. Patient is relieved from intractable pain and is leading a good quality of life.