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阴茎转移作为结直肠癌的首发症状:1例罕见病例报告

Penile Metastasis as the Presenting Symptom of Colorectal Carcinoma: A Rare Case Report.

作者信息

Patel Mann, Kaldany Alain, Tanko Farida, Parrott Andrew, Jang Thomas L

机构信息

Department of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

Department of Pathology and Laboratory Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.

出版信息

Case Rep Urol. 2025 May 26;2025:8856762. doi: 10.1155/criu/8856762. eCollection 2025.

Abstract

Secondary penile cancer, despite the region's rich vascularization, is a rare phenomenon with only around 500 cases ever reported, typically of genitourinary origin and in even rarer cases, of colorectal adenocarcinoma. Unfortunately, the underlying mechanisms are not well elucidated, and prognosis remains poor with a late onset and median overall survival of 9 months for colon adenocarcinoma. Secondary penile cancer often presents alongside concurrent metastases months or years following successful treatment of the primary tumor. However, we report a case of an isolated penile metastasis as the presenting symptom of colon adenocarcinoma with no identifiable primary lesion or history of malignancy. A 67-year-old African-American male presented with a 1-month history of voiding symptoms, whereupon follow-up revealed a penile mass near the left base of the penis. Postoperative histopathological, immunohistochemical, and genomic analyses revealed characteristics of invasive and metastatic colorectal adenocarcinoma. Initial diagnostic testing revealed elevations in serum tumor markers CA 19-9 and carcinoembryonic antigen, while whole body PET/CT scan and colonoscopy failed to identify any tumorigenic lesions or primary colorectal malignancy. Although hypermetabolic activity was noted near the base of the penis and bilateral inguinal lymph nodes, the patient is currently on chemotherapy with a modified FOLFOX-6 regimen with active surveillance and no adverse effects. Here, we report a rare case of isolated penile metastasis as the first presentation of colon adenocarcinoma with no primary lesion. Regardless of origin, secondary penile cancer is a rare phenomenon with a poor prognosis. While the exact mechanism of spread is uncertain, the most probable mode of dissemination is through venous networks. There is also no standard of treatment relying on surgical, therapeutic, and palliative management. Although unclear, our unique presentation may portend a more favorable prognosis with continued treatment and observation.

摘要

继发性阴茎癌,尽管该区域血管丰富,但却是一种罕见现象,仅有约500例报道,通常起源于泌尿生殖系统,更罕见的是起源于结直肠癌。不幸的是,其潜在机制尚未完全阐明,预后仍然很差,发病较晚,结肠腺癌的中位总生存期为9个月。继发性阴茎癌通常在原发性肿瘤成功治疗数月或数年后伴有同时发生的转移。然而,我们报告了一例孤立性阴茎转移作为结肠腺癌的首发症状,无明确的原发性病变或恶性肿瘤病史。一名67岁的非裔美国男性出现排尿症状1个月,随后的随访发现阴茎左侧基部附近有一个肿块。术后组织病理学、免疫组织化学和基因组分析显示为浸润性和转移性结肠腺癌的特征。初始诊断测试显示血清肿瘤标志物CA 19-9和癌胚抗原升高,而全身PET/CT扫描和结肠镜检查未能发现任何致瘤性病变或原发性结肠恶性肿瘤。尽管在阴茎基部和双侧腹股沟淋巴结附近发现了高代谢活性,但患者目前正在接受改良的FOLFOX-6方案化疗,积极监测且无不良反应。在此,我们报告一例罕见的孤立性阴茎转移作为结肠腺癌的首发表现且无原发性病变的病例。无论起源如何,继发性阴茎癌都是一种罕见现象,预后不良。虽然确切的传播机制尚不确定,但最可能的传播方式是通过静脉网络。也没有依靠手术、治疗和姑息治疗的标准治疗方法。虽然尚不清楚,但我们独特的表现可能预示着持续治疗和观察会有更有利的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e6f7/12129613/f32bf427561b/CRIU2025-8856762.001.jpg

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