Case for Diagnosis
Ulcerated Penile Lesion
Lesión ulcerada en pene
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Martínez Lorenzo, B. Moreno Torres, A.I. Sánchez Moya" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E.R." "apellidos" => "Martínez Lorenzo" "email" => array:1 [ 0 => "elenamartinezlorenzo@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Moreno Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.I." 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The lesion had started as a papular lesion that then ulcerated spontaneously and oozed a whitish matter. It had remained stable since. The patient reported that he had no other symptoms or similar lesions and confirmed that he had not engaged in risky sexual behavior. His past history was remarkable for a moderately differentiated invasive rectal adenocarcinoma that had been detected 16 months earlier (T3, N2b, M1a). The tumor had been treated with surgery, chemotherapy, and radiotherapy, and the patient had been in complete remission for the last 6 months.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a 4-mm ulcer on the lateral aspect of the glans. The ulcer had a pink-erythematous background and traces of fibrin at its edges (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). It was located on a well-delimited, indurated 1.5-cm plaque that had a stone-like consistency and was painful to the touch. No other cutaneous or mucosal lesions were observed and the inguinal lymph nodes were not enlarged on palpation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histologic examination showed an infiltrate consisting of glandular formations (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) that stained positively with cytokeratin 20 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and negatively with cytokeratin 7 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B) in the immunohistochemical evaluation.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">A basic blood workup including tumor markers and serology was normal, and the patient also tested negative for human papillomavirus. A computed tomography (CT) scan of the chest, abdomen, and pelvis ruled out locoregional and distant disease.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Cutaneous penile metastasis from rectal adenocarcinoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">A positron emission tomography–CT scan performed following diagnosis detected focal metabolic activity involving the glans, sacral alae, and iliac chains, indicating tumor invasion. The patient was started on palliative chemotherapy.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">The first case of penile metastasis from rectal adenocarcinoma was reported in 1950<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and just 25 cases have been published since. Metastases of this type are rare, even though the penis is highly vascularized and located very close to the rectum. The mechanism of spread to this rare location is still unknown.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The theory with the greatest support is hematogenous spread resulting from retrograde embolization of the deep pudendal venous system; other theories include lymphatic spread through the hypogastric nodal group, spread through the perineural space, direct spread, and even inadvertent spread during surgery. Metastatic tumors of the penis usually appear within 18 months of primary diagnosis, although one-third occur synchronously.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Cutaneous metastases to the penis have a highly variable clinical presentation,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> the most common of which is an indurated plaque or nodule that may or may not be ulcerated. The lesions are generally asymptomatic, although there may be perianal pain, priapism, hematuria, and urinary obstruction. They are typically located on the body of the penis and are rarely found on the glans or prepuce.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Both primary and secondary tumors of the penis should be included in the differential diagnosis. Primary tumors that should be contemplated include squamous cell carcinoma, adenosquamous carcinoma,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and other penile adenocarcinomas, such as Littré gland carcinoma, melanoma, and sarcoma. Secondary tumors account for just 0.8% of all tumors of the penis, but of note in this category are genitourinary tumors (tumors of the bladder and prostate adenocarcinoma), which account for approximately 70% of primary tumors that metastasize to the penis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Cutaneous metastases have a dismal prognosis,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and those involving the penis are associated with an overall survival of less than 1 year after diagnosis,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> as their presence tends to reflect disease spread. There is no established treatment. Management tends to be palliative, with chemotherapy and/or radiotherapy. Surgery is reserved for solitary metastases.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We have reported a rare case of cutaneous metastasis from rectal adenocarcinoma. The case is of particular interest because of its atypical location and its occurrence in a patient who appeared to be in complete remission at the time of diagnosis.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 8 => array:2 [ "identificador" => "xack364962" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorenzo ERM, Torres BM, Moya AIS. Lesión ulcerada en pene. Actas Dermosifiliogr. 2018;109:643–644.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 637 "Ancho" => 850 "Tamanyo" => 101198 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 638 "Ancho" => 850 "Tamanyo" => 251028 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin, original magnification x10.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 524 "Ancho" => 1400 "Tamanyo" => 368866 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Cytokeratin x20, positive. x 10. 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"fecha" => "2015" "volumen" => "87" "paginaInicial" => "171" "paginaFinal" => "172" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26150041" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack364962" "titulo" => "Acknowledgments" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">We thank the Hospital of Toledo and the Oncology Department at this hospital for their help.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302130/v1_201809020417/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000007/v1_201809020417/S1578219018302130/v1_201809020417/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302130?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 6 | 17 |
| 2024 October | 101 | 32 | 133 |
| 2024 September | 112 | 25 | 137 |
| 2024 August | 141 | 50 | 191 |
| 2024 July | 123 | 29 | 152 |
| 2024 June | 96 | 40 | 136 |
| 2024 May | 112 | 31 | 143 |
| 2024 April | 93 | 28 | 121 |
| 2024 March | 88 | 37 | 125 |
| 2024 February | 65 | 27 | 92 |
| 2024 January | 81 | 39 | 120 |
| 2023 December | 75 | 25 | 100 |
| 2023 November | 82 | 28 | 110 |
| 2023 October | 73 | 29 | 102 |
| 2023 September | 80 | 38 | 118 |
| 2023 August | 54 | 10 | 64 |
| 2023 July | 64 | 36 | 100 |
| 2023 June | 73 | 25 | 98 |
| 2023 May | 68 | 27 | 95 |
| 2023 April | 65 | 23 | 88 |
| 2023 March | 64 | 31 | 95 |
| 2023 February | 48 | 26 | 74 |
| 2023 January | 48 | 45 | 93 |
| 2022 December | 45 | 62 | 107 |
| 2022 November | 38 | 24 | 62 |
| 2022 October | 31 | 26 | 57 |
| 2022 September | 33 | 36 | 69 |
| 2022 August | 26 | 28 | 54 |
| 2022 July | 26 | 44 | 70 |
| 2022 June | 45 | 27 | 72 |
| 2022 May | 51 | 33 | 84 |
| 2022 April | 73 | 44 | 117 |
| 2022 March | 68 | 46 | 114 |
| 2022 February | 39 | 24 | 63 |
| 2022 January | 78 | 44 | 122 |
| 2021 December | 88 | 50 | 138 |
| 2021 November | 63 | 56 | 119 |
| 2021 October | 54 | 58 | 112 |
| 2021 September | 39 | 42 | 81 |
| 2021 August | 38 | 38 | 76 |
| 2021 July | 35 | 41 | 76 |
| 2021 June | 47 | 40 | 87 |
| 2021 May | 47 | 53 | 100 |
| 2021 April | 104 | 80 | 184 |
| 2021 March | 68 | 46 | 114 |
| 2021 February | 58 | 51 | 109 |
| 2021 January | 33 | 41 | 74 |
| 2020 December | 53 | 53 | 106 |
| 2020 November | 51 | 45 | 96 |
| 2020 October | 29 | 18 | 47 |
| 2020 September | 41 | 27 | 68 |
| 2020 August | 37 | 26 | 63 |
| 2020 July | 26 | 22 | 48 |
| 2020 June | 49 | 39 | 88 |
| 2020 May | 17 | 19 | 36 |
| 2020 April | 8 | 10 | 18 |
| 2020 March | 20 | 13 | 33 |
| 2020 February | 7 | 0 | 7 |
| 2019 May | 1 | 0 | 1 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
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