Malignant priapism

Case contributed by Dr Pramod Gupta

Presentation

Three month history of new-onset progressive penile swelling and tenderness.

Patient Data

Age: 75 years
Gender: Male
MRI

The sagittal and coronal T2 weighted images show erect penis with both corpora cavernosa infiltrated with innumerable hypointense nodules of variable sizes. Contrast-enhanced fat suppressed T1 weighted sagittal and coronal images show these nodules to be hypoenhancing as compared to barely spared enhancing normal corpora.

The patient underwent true-cut needle biopsies of the penile shaft in the operating room. Pathological diagnosis was metastatic poorly differentiated carcinoma.

Case Discussion

Malignant priapism is defined as a persistent, painful, and nonsexual erection due to malignant cells infiltrating the cavernous sinuses and associated venous system of penis 1. It occurs in 20-50% of cases of penile metastases. Other manifestations of penile metastases include indurated nodules, penile masses and skin lesions 2.

The majority (nearly 70%) of the penile metastases arise from primary malignancies of the genitourinary tract such as prostate and urinary bladder 3. Metastatic spread of malignancy to the penis represents an advanced stage of the disease, and the prognosis is generally poor 1-3.

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