Abstract
Background. Malignant priapism is a painful lesion and persistent erection of the penis due to metastatic infiltration by a neoplasm. Secondary penile malignancy, as a consequence of metastatic disease, is a rare event. This indicates the progression of the main disease and an unfavorable outcome. Most cases of metastatic penile cancer are from the urogenital region: the prostate 33%, the urinary bladder 30%, the kidneys 8% and gastrointestinal tract 8%.
Aim. To describe the case of malignant refractory priapism in bladder cancer patient.
Materials and methods. A 49-year-old patient with pT4aN3M0 stage IIIB low-grade bladder cancer received the complex treatment and was under observation. Combined 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) using GE Healthcare Optima PET/CT 560 scanner was performed.
Results. The patient with poorly differentiated bladder cancer underwent transurethral resection followed by 3 cycles of neoadjuvant polychemotherapy using Gemzar plus cisplatin scheme. The surgery concerning cystprostatectomy, pelvic lymphadenectomy, urethrectomy and the Bricker operation was performed after the development of relapse. The histological examination of the bladder tissue showed the presence of poorly differentiated urothelial cancer, invading all the layers with invasion into the seminal vesicles and prostate. The lesion in the root of the penis that were growing and associated with the tensive pain was diagnosed 7 months after the surgical treatment. The intensity of these manifestations was increasing within 2 weeks. During the physical examination the penis was enlarged, solid, rigid and painful on palpation. According to 18F-FDG PET/CT study the metastatic penile cancer complicated with priapism was diagnosed.
Conclusion. Malignant priapism is a rare condition. The most often cause of malignant priapism development is urogenital tract tumors, in particular urothelial cancer. Refractory priapism is characterized by the increase of the local manifestations over time. 18F-FDG PET/CT is the method of choice for the diagnosis of malignant priapism.