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Year : 2020  |  Volume : 35  |  Issue : 2  |  Page : 165-166  

Penile metastasis from renal cell carcinoma: Diagnosis and posttreatment response seen on fluorodeoxyglucose positron emission tomography–computed tomography


1 Department of Nuclear Medicine and PET-CT, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
2 Department of Surgical Oncology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India

Date of Submission01-Jan-2020
Date of Acceptance14-Jan-2020
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Prathamesh Vijay Joshi
Department of Nuclear Medicine and PET-CT, Kamalnayan Bajaj Hospital, Beed Bypass Road, Aurangabad - 431 010, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_1_20

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   Abstract 


We present fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) findings in an extremely rare case of penile metastasis from renal cell carcinoma. A 66-year-old male, a known case of renal cell carcinoma, underwent FDG PET-CT. The scan showed metabolically active cervical lymph nodes, lytic skeletal lesions, deposit in the left adrenal gland, and nodules in the bilateral lungs, indicating metastatic disease. In addition, a hypermetabolic lesion was seen in the corpus cavernosum of the shaft of the penis, suggestive of penile metastasis. Follow-up PET-CT after tyrosine kinase inhibitor therapy showed reduction in size and metabolic activity of all previously seen lesions including penile lesion, suggestive of favorable response to therapy.

Keywords: Fluorodeoxyglucose positron emission tomography–computed tomography, penile metastases, renal cell carcinoma, tyrosine kinase inhibitor


How to cite this article:
Joshi PV, Saoji R, Kulkarni M, Kumar K. Penile metastasis from renal cell carcinoma: Diagnosis and posttreatment response seen on fluorodeoxyglucose positron emission tomography–computed tomography. Indian J Nucl Med 2020;35:165-6

How to cite this URL:
Joshi PV, Saoji R, Kulkarni M, Kumar K. Penile metastasis from renal cell carcinoma: Diagnosis and posttreatment response seen on fluorodeoxyglucose positron emission tomography–computed tomography. Indian J Nucl Med [serial online] 2020 [cited 2020 Jul 10];35:165-6. Available from: http://www.ijnm.in/text.asp?2020/35/2/165/280437



A 66-year-old male, a case of left renal cell carcinoma, had undergone radical nephrectomy a year ago. The histopathology evaluation had revealed clear cell type of renal cell carcinoma with sarcomatoid differentiation. During clinical follow-up, he complained of left arm pain and bilateral neck swellings. Ultrasonography revealed multiple, bilateral cervical lymph nodes with loss of fatty hilum, suggestive of metastatic lymphadenopathy. Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) was advised to evaluate the whole-body status of disease. After overnight fasting, 7 mCi of FDG was injected intravenously and whole-body FDG PET-CT was performed 60 min later. Intravenous CT contrast was not administered due to deranged kidney function.

The PET-CT [Figure 1]a, maximum intensity projection image] showed metabolically active bilateral cervical lymph nodes (green arrow), lytic skeletal lesion in the left humerus shaft (short black arrow), lytic skeletal lesion in the left acetabulum (long black arrow), deposit in the left adrenal gland (blue arrow), and nodules in the bilateral lungs, indicating metastatic disease. In addition, an ill-defined, FDG-avid lesion was seen in the left corpus cavernosum of the shaft of the penis causing deviation of septum to right [red arrow in [Figure 1]a and [Figure 1]c. On questioning, the patient admitted of having mild dysuria; however, no penile pain, hematuria, or cutaneous ulceration was reported. In setting of multiple visceral metastatic diseases seen at other sites, biopsy was avoided and this FDG-avid penile lesion was interpreted as penile metastasis.
Figure 1: Positron emission tomography–computed tomography (a: maximum intensity projection) showed metastatic disease in cervical lymph nodes (green arrow), skeletal lesion in the left humerus (short black arrow), lesion in the left acetabulum (long black arrow), deposit in the left adrenal gland (blue arrow), and nodules in the bilateral lungs. In addition, an ill-defined, fluorodeoxyglucose-avid lesion was seen in the shaft of the penis causing deviation of septum to right (red arrow in a and c). Follow-up positron emission tomography–computed tomography after tyrosine kinase inhibitor therapy (maximum intensity projection: b) showed significant morphological and metabolic reduction in all previously seen lesions including penile lesion (red arrow d)

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The patient was treated with tyrosine kinase inhibitor (TKI) therapy with oral pazopanib. Post-TKI therapy, the patient reported gradual relief of bone pain along with reduction in cervical lymphadenopathy. Follow-up PET-CT was performed 6 months after initiating TKI therapy. The follow-up PET-CT [MIP image, [Figure 1]b showed significant morphological and metabolic reduction in all previously seen lesions including penile lesion [red arrow, [Figure 1]d, suggestive of favorable response to therapy.

Penile metastases are extremely rare with <500 cases reported.[1] Common primaries that metastasize to the penis include bladder, prostate, colon, rectum, and kidney.[2],[3],[4] Clinical presentation mainly includes penile pain, palpable nodules, and priapism. Increased penile size, cutaneous ulceration, dysuria, and hematuria may also occur.[5]

Penile involvement in any primary malignancy indicates grave prognosis as it indicates disseminated disease. The median survival of such patients varies from 6 months to 2 years.[6],[7] However, significant advances have been made in the last decade since the introduction of different TKIs such as sunitinib, pazopanib, and sorafenib.[8] In our case, significant reduction in disease activity was observed after TKI therapy.

Our case highlights the role of whole-body imaging and exquisite sensitivity offered by FDG PET-CT in diagnosing rare occurrence of penile metastasis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Zhang K, Da J, Yao HJ, Zheng DC, Cai ZK, Jiang YQ, et al. Metastatic tumors of the penis: a report of 8 cases and review of the literature. Medicine (Baltimore) 2015;94:e132.  Back to cited text no. 1
    
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Burgers JK, Badalament RA, Drago JR. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am 1992;19:247-56.  Back to cited text no. 2
    
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Parida GK, Tripathy S, Roy SG, Singhal A, Das C, Shamim SA. Incidentally detected penile metastases in a patient of carcinoma urinary bladder on follow-up FDG PET/CT. Clin Nucl Med 2017;42:e273-4.  Back to cited text no. 3
    
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Ketata S, Boulaire JL, Soulimane B, Bargain A. Metachronous metastasis to the penis from a rectal adenocarcinoma. Clin Colorectal Cancer 2007;6:657-9.  Back to cited text no. 4
    
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Morichetti D, Mazzucchelli R, Lopez-Beltran A, Cheng L, Scarpelli M, Kirkali Z, et al. Secondary neoplasms of the urinary system and male genital organs. BJU Int 2009;104:770-6.  Back to cited text no. 5
    
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Robey EL, Schellhammer PF. Four cases of metastases to the penis and a review of the literature. J Urol 1984;132:992-4.  Back to cited text no. 6
    
7.
Rouanne M, Alhammadi A, Vilain D, Radulescu C, Lebret T. Value of positron emission tomography in diagnosing synchronous penile metastasis from urothelial bladder cancer. World J Surg Oncol 2015;13:276.  Back to cited text no. 7
    
8.
Rudresha AH, Chaudhuri T, Lakshmaiah KC, Babu GK, Lokanatha D, Jacob LA, et al. First-line tyrosine kinase inhibitors in metastatic renal cell carcinoma: A regional cancer center experience. Indian J Cancer 2017;54:626-30.  Back to cited text no. 8
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