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Not all lumps in the penis are a Peyronie's plaque.
A man of 61 came to the urology outpatient clinic requesting a second opinion. He was experiencing urinary frequency and urgency as well as erectile dysfunction and had noticed a tender lump at the base of the penis. 6 weeks earlier a consultant urologist had diagnosed Peyronie's disease. On questioning it transpired that 6 years previously he had undergone a right hemicolectomy for an adenomatous polyp and he gave a family history of largebowel cancer, affecting two first-degree relatives. On examination there was a hard, tender dorsal mass at the base of the penis, seeming to involve both corpora. A large mass was also noted in the left iliac fossa. Open biopsy of the penile lesion revealed mucin-secreting adenocarcinoma. On subsequent colonoscopy a large primary adenocarcinoma was found in the sigmoid colon. Magnetic resonance imaging demonstrated the cavernosal lesion and confirmed the presence of widespread peritoneal disease with omental ‘cake’ (Figure 1). Metastases were present in the lungs, pelvis and femur. The patient subsequently underwent chemotherapy and palliative radiotherapy.
Secondary malignancies of the penis are uncommon and tend to originate from pelvic urogenital primary tumours (in about 70% of cases1). Colonic adenocarcinoma seldom presents in this way and when it does so the disease process is invariably advanced. The mechanism may be via direct extension, retrograde lymphatic spread, retrograde venous spread, direct arterial extension or secondary embolism2. The first sign of metastatic penile disease may be a corporal mass (as in this case), a cutaneous nodule or erythema3, malignant priapism4 or simply nonspecific lower urinary tract symptoms. Although penile secondary tumours seem much rarer than Peyronie's disease, clinicians should bear them in mind. Unfortunately, the penis is often overlooked during general examination and thus such lesions are probably under-reported.