Shimoda Hiroki, Suzuki Issei, Kijima Toshiki, Imasato Naoki, Kokubun Hidetoshi, Nakamura Gaku, Takei Kohei, Nishihara Daisaku, Betsuno Hironori, Yashi Masahiro, Kamai Takao
The Department of Urology, Dokkyo Medical University Hospital.
Hinyokika Kiyo. 2023 Jul;69(7):199-202. doi: 10.14989/ActaUrolJap_69_7_199.
A 42-year-oldman visited our hospital because of gradually worsening penile swelling over 3 weeks. A hard mass on the glans was palpated; however, we were unable to observe it due to severe phimosis. Magnetic resonance imaging of the pelvis revealed enlargement of glans and swelling of bilateral inguinal lymph nodes as both showed a low signal intensity on T2-weightedimaging, a high signal intensity on diffusion-weighted imaging, and a low signal intensity on the apparent diffusion coefficient map. Fluorine- 18-deoxyglucose (FDG) positron emission tomography showed FDG uptake at the external iliac, common iliac, obturator, and cervical lymph nodes besides the glans and inguinal lymph nodes. Although his serum squamous cell carcinoma antigen level was within the normal range, his soluble interleukin-2 receptor concentration was elevated to 2,290 U/ml. Therefore, we diagnosed these lesions as penile cancer with multiple lymph node metastases, with a possible differential diagnosis of malignant lymphoma. We planned a penile needle biopsy; however, the rapid plasma reagin test and treponema pallidum hemagglutination test, which were performed during the preoperative examination, were positive and led to a diagnosis of secondary syphilis. The patient was treated with oral amoxicillin at 1,500 mg/day for 8 weeks. The penile and lymph node swelling subsided after starting medication.
一名42岁男性因阴茎肿胀逐渐加重3周前来我院就诊。触诊发现龟头有一硬块；然而，由于严重包茎，我们无法观察到它。骨盆磁共振成像显示龟头增大，双侧腹股沟淋巴结肿大，两者在T2加权成像上均呈低信号强度，在扩散加权成像上呈高信号强度，在表观扩散系数图上呈低信号强度。氟-18-脱氧葡萄糖（FDG）正电子发射断层扫描显示，除龟头和腹股沟淋巴结外，髂外、髂总、闭孔和宫颈淋巴结有FDG摄取。虽然他的血清鳞状细胞癌抗原水平在正常范围内，但他的可溶性白细胞介素-2受体浓度升高至2290 U/ml。因此，我们将这些病变诊断为阴茎癌伴多发淋巴结转移，可能的鉴别诊断为恶性淋巴瘤。我们计划进行阴茎穿刺活检；然而，术前检查时进行的快速血浆反应素试验和梅毒螺旋体血凝试验均为阳性，最终诊断为二期梅毒。该患者接受了每天1500毫克阿莫西林口服治疗，持续8周。开始用药后，阴茎和淋巴结肿胀消退。
