British Journalof Urology (1987), 60,368-375 0 1987 British Journal of Urology

Case Reports

Metastases to the Penis from Carcinoma of the Stomach

N . D. KARANJlAand HILARY KING, Department of General Surgery, and F. A. W . SCHWEITZER, Department of Urology, Royal Surrey County Hospital, Guildford

A 65-year-old man first presented in 1976 with dysphagia. Oesophagoscopy showed tumour at the cardia. He underwent a radical oesophago-gastrec- tomy. Histology showed a well differentiated carci- noma infiltrating perigastric fat but without nodal involvement. He remained asymptomatic until January 1985, when he developed a right vocal cord paresis. A bone scan showed multiple skeletal metastases. Shortly afterwards he developed a right supraclavicular mass which was biopsied. Histolog- ical appearances were of a metastatic well differ- entiated carcinoma of the stomach. The nodes were irradiated and diminished in size. In September 1985 he presented with hard nodules in the corpora cavernosa penis. A biopsy confirmed metastatic carcinoma of the stomach (Fig.). Further local radiotherapy dispersed these.

Comment

Metastases to the penis are rare. Eberth (1870) first described a case of rectal cancer with penile metastases. Powell et al. (1985) reviewed 219 patients with penile metastases reported in the literature and found that the most frequent primary sites were in the genito-urinary tract (7573, includ- ing bladder, prostate, kidney, testis and ureter in order of frequency, followed by the gastrointestinal tract (1 773, including rectum/sigmoid, colon, anus, liver and pancreas. Rare primaries included carci- noma of the lung, nasopharyngeal carcinoma, lymphosarcoma/reticulum cell sarcoma, giant cell tumours of bone, Burkitt’s lymphoma and malig- nant melanoma.

In most cases penile disease is a manifestation of advanced malignancy. Presenting features include local masses, urinary retention, priapism and

Fig. Section of penile nodule showing metastatic moderately differentiated carcinoma of acinar, acid mucin secreting pattern consistent with a primary site in the stomach.

haematuria, but pain and ulceration are uncommon (Powell et al., 1985). Amputation of the penis and radiotherapy have been tried with little success. Surgery should be reserved for patients with unrelieved symptoms or those with no evidence of other metastases. Abeshouse and Abeshouse (1961) reported a bleak outlook whatever treatment was used and this has since been confirmed. We believe this to be the first report of metastases to the penis from carcinoma of the stomach.

References Abeshouse,B. S.andAbeshouse,C. A. ( 1961). Metastatic tumours

of the penis: a review of the literature and a report of two cases. J. Urol., 86,99-I 12.

Eberth, C. J. (1870). Krebsmetastases des corpus cavernosum Penis. Virchows Arch. (Pathol. Anat . ) , 51, 145-146.

Powell, B. L., Craig, J. B. and Muss, H. B. (1985). Secondary malignancies of the penis and epididymis: a case report and review of the literature. J . Clin. Oncol., 3. 110-1 16.

Requestsfor reprintsto: N . D. Karanjia, Departmentof General Surgery, Royal Surrey County Hospital, Everton Road, Park Barn, Guildford, Surrey.

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