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J R Soc Med. 2002 January; 95(1): 38–39.
PMCID: PMC1279149

A lump in the penis

M Harper, FRCS, M Arya, FRCS, and P J R Shah, FRCS

Not all lumps in the penis are a Peyronie's plaque.

CASE HISTORY

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.

Figure 1
Magnetic resonance imaging scan showing sagittal corporal mass as well as large primary colonic tumour

COMMENT

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.

References

1. Powell BL, Craig JB, Muss HB. Secondary malignancies of the penis and epididymis: a case report and review of the literature. J Clin Oncol 1985;3: 110-16 [PubMed]
2. Trulock TS, Wheatley JK, Walton KN. Secondary tumours of the penis. Urology 1981;17: 563-5 [PubMed]
3. Belville WD, Cohen JA. Secondary penile malignancies: the spectrum of presentation. J Surg Oncol 1992;51: 134-7 [PubMed]
4. Chan PYK, Begin LR, Arnold D, Jocobson SA, Corcos J, Brock GB. Priapism secondary to penile metastasis: a report of two cases and a review of the literature. J Surg Oncol 1998;68: 51-9 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press