The first case of penile metastases of adrenocortical cancer: A clinical case

Metastases of malignant neoplasms into the penis from various primary locations are extremely rare. These lesions are due to the disseminated tumor. In most cases, the primary tumors are located in the genitourinary system (75%), gastrointestinal tract (21%), and lungs (7%). The prognosis is poor, with most patients dying within a year of diagnosis. The purpose of the article is to present a rare case of metastatic lesion of the penis in adrenocortical cancer. A 59-year-old patient with a stage III right adrenal tumor pT3N0M0 had undergone an adrenalectomy. Histological and immunohistochemical studies showed the classic version of adrenocortical cancer with Ki-67 40%. Mitotane with polychemotherapy according to the EP-M scheme was administered for the adjuvant purpose. In 3 months, the patient developed induration and local soreness in the root of the penis. Magnetic resonance imaging of the pelvic organs showed a hypodense zone in the cavernous bodies. Combined positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose showed a mass in the left cavernous body with increased radiopharmaceutical uptake. Specific lesions were found in the mediastinal and retroperitoneal lymph nodes, liver, bed of the removed tumor, and soft tissues of the lumbar region. Tumor generalization with multiple synchronous metastases, including the penis, was established. Cytological examination of the punctate showed malignant cells. Palliative polychemotherapy was administered according to the EDP-M regimen with glucocorticoids. The treatment had no effect. The patient died 7 months after the establishment of penile metastasis. This case of a penile metastatic lesion in a patient with primary adrenocortical cancer is presented for the first time in the available literature. The main symptoms of the disease are the presence of a tumor in the area of the root of the penis and local pain. Magnetic resonance imaging and combined positron emission and X-ray computed tomography with 18-fluorodeoxyglucose are methods of choice for medical imaging that reliably determine the tumor extension. The location of the primary tumor outside the pelvis in a patient with penile metastases is usually accompanied by multiple synchronous metastases involving other organs.