More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research

More results...

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Abdominal Radiology, Original Research
Abdominal Radiology, Pictorial Essay
Anthropology and Dental Radiology, Original Research
Breast Imaging, Case Report
Breast Imaging, Original Research
Breast Imaging, Pictorial Essay
Breast Imaging, Review Article
Cardiopulmonary Imaging, Case Report
Cardiopulmonary Imaging, Case Series
Cardiopulmonary Imaging, Education
Cardiopulmonary Imaging, Original Research
Cardiopulmonary Imaging, Pictorial Essay
Cardiopulmonary Imaging, Review Article
Case Report
Case Report, Breast Imaging
Case Report, Cardiopulmonary Imaging
Case Report, Diagnostic Radiology
Case Report, Neuroradiology/Head and Neck Imaging
Case Report, Vascular and Interventional Radiology
Case Series
Case Series, Abdominal Radiology
Case Series, Diagnostic Radiology
Case Series, Musculoskeletal Imaging
Case Series, Vascular and Interventional Radiology
DENTAL ARTICLE
Dental Radiology, Case Report
Dental Radiology, Case Series
Dental Radiology, Original Research
Diagnostic Radiology, Case Report
Diagnostic Radiology, Case Series
Diagnostic Radiology, Original Research
Diagnostic Radiology, Pictorial Essay
Diagnostic Radiology, Review Article
Editorial
Education
Education, Diagnostic Radiology
Education, Imaging science
Education, Original Research
Emergency, Original Research
Erratum
Gastrointestinal Imaging, Case Report
Gastrointestinal Imaging, Case Series
Gastrointestinal Imaging, Original Research
Gastrointestinal Imaging, Pictorial Essay
General and Emergency Radiology, Original Research
General and Emergency Radiology, Review Article
Genitourinary and Gynecologic Imaging, Case Report
Genitourinary and Gynecologic Imaging, Original Research
Imaging Science, Original Research
Interventional Radiology, Original Research
Letter to Editor
Musculoskeletal Imaging, Case Report
Musculoskeletal Imaging, Original Article
Musculoskeletal Imaging, Original Research
Musculoskeletal Imaging, Pictorial Essay
Musculoskeletal Imaging, Review Article
Neuroradiology , Review Article
Neuroradiology Head and Neck Imaging, Pictorial Essay
Neuroradiology, Case Report
Neuroradiology, Pictorial Essay
Neuroradiology/Head and Neck Imaging, Case Report
Neuroradiology/Head and Neck Imaging, Case Series
Neuroradiology/Head and Neck Imaging, Original Research
Neuroradiology/Head and Neck Imaging, Review Article
Neuroradiology/Spine Imaging, Original Research
Notice of Retraction
Nuclear Medicine, Case Report
Nuclear Medicine, Original Research
Nuclear Medicine, Pictorial Essay
Original Article
Original Article, Neuroradiology
Original Research
Original Research Article
Original Research, Cardiopulmonary Imaging
Original Research, Dental Radiology
Original Research, Descriptive Study
Original Research, Diagnostic Radiology
Original Research, Gastrointestinal Imaging
Original Research, Genitourinary and Gynecologic Imaging
Original Research, Musculoskeletal Imaging
Original Research, Neuroradiology/Head and Neck Imaging
Original Research, Nuclear Medicine
Original Research, Vascular and Interventional Radiology
Pediatric Imaging, Case Report
Pediatric Imaging, Pictorial Essay
PICTORIAL ESSAY
Pictorial essay, Musculoskeletal Imaging
Pictorial essay, Neuroradiology/Head and Neck Imaging
PICTORIAL REVIEW
Radiologic-Pathologic Correlation
RADIOLOGICAL-PATHOLOGICAL CORRELATION
Radiology Business, Original Research
Research Article
Review Article
Review Article, Diagnostic Radiology
Review Article, Gastrointestinal imaging
Review Article, Musculoskeletal
Review Article, Musculoskeletal Imaging
Review Article, Vascular and Interventional Radiology
Technical Innovation
Technical Innovation, Cardiopulmonary Imaging
Technical Innovation, Gastrointestinal Imaging
Ultrasound, Case Report
Ultrasound, Original Research
Ultrasound, Review Article
Vascular and International Radiology, Case Report
Vascular and Interventional Radiology, Case Report
Vascular and Interventional Radiology, Case Series
Vascular and Interventional Radiology, Original Research
Vascular and Interventional Radiology, Pictorial Essay
Vascular and Interventional Radiology, Review Article
Vascular and Interventional Radiology, Short Communication
Vascular and Interventional, Original Research
View/Download PDF

Translate this page into:

CASE REPORT
2015
:5;
15
doi:
10.4103/2156-7514.153971

Isolated Asymptomatic Metastasis in the Myocardium: A Rare Scenario in Case of Carcinoma Penis

Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India

Address for correspondence: Dr. Santosh Kumar, Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Haryana and Punjab, India. E-mail: santoshsp1967jaimatadi@yahoo.co.in

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Penile cancer is a common malignancy in developing countries. It commonly metastasizes to the lymph nodes, lung, liver, and bones. Myocardial metastasis is rare. A 40-year-old male patient presented with ulcerative growth over glans penis. Histologic evaluation of the biopsy sample diagnosed the lesion as squamous cell cancer. Assessment of the stage of the disease revealed cardiac metastasis. Patient received six cycles of chemotherapy. He partially responded, but later succumbed to cardiac failure due to pericardial and pleural effusion.

Keywords

Carcinoma penis
cardiac metastases
chemotherapy
lymph nodes
pericardial effusion

INTRODUCTION

Squamous cell carcinoma (SCC) of the penis is common in Asia and management is technically challenging for the urologist. SCC of the penis most commonly metastasizes to the lymph nodes, lung, liver, and bones. The spread of the tumor to the loco-regional lymph nodes (lymph node positivity) is the most relevant prognostic factor. Myocardial metastases have been reported in autopsy studies.[12]

CASE REPORT

A 40-year-old male presented to our institute with a lesion over the glans penis that had developed over 6 months. Examination revealed a large ulceroproliferative lesion over the glans penis with bilateral fixed and matted inguinal lymph nodes. Wedge biopsy report identified the lesion to be squamous cell cancer of the penis. The patient underwent partial penectomy and fine needle aspiration cytology of bilateral inguinal nodes, both of which revealed moderately differentiated SCC. A contrast-enhanced computed tomography [Figure 1a and b] and 2-deoxy-2-(fluorine-18)fluoro-d-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) [Figure 2a and b] done to evaluate the stage of the disease revealed bilateral inguinopelvic lymphadenopathy and a large right ventricular myocardial metastasis. However, the patient never had any cardiac symptoms or electrocardiographic abnormalities. He received local pelvic radiotherapy and six cycles of systemic chemotherapy with a combination of cisplatin, ifosfamide, and paclitaxel. Follow-up examination and imaging revealed partial response with improvement in the general condition and shrinkage of the inguinal lymph nodes and the cardiac lesion [Figures 3 and 4].

40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Contrast enhanced CT of (a) abdomen axial view reveals bilateral inguinal nodes (arrows) and of (b) chest shows cardiac lesion (arrow) suggestive of metastatic disease.
Figure 1
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Contrast enhanced CT of (a) abdomen axial view reveals bilateral inguinal nodes (arrows) and of (b) chest shows cardiac lesion (arrow) suggestive of metastatic disease.
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. PET CT scan of the patient reveals intense FDG uptake lesion in (a) pelvic region by the bilateral inguinal nodes (arrows) and in the (b) chest region by the cardiac lesions (standardised standardized uptake value - 9.8) suggestive of metastatic disease.
Figure 2
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. PET CT scan of the patient reveals intense FDG uptake lesion in (a) pelvic region by the bilateral inguinal nodes (arrows) and in the (b) chest region by the cardiac lesions (standardised standardized uptake value - 9.8) suggestive of metastatic disease.
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. After six cycles of chemotherapy contrast enhanced CT of the (a) pelvic region shows partial response in the bilateral inguinal nodes (arrows) and (b) CECT chest shows reduction the cardiac lesion (arrow).
Figure 3
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. After six cycles of chemotherapy contrast enhanced CT of the (a) pelvic region shows partial response in the bilateral inguinal nodes (arrows) and (b) CECT chest shows reduction the cardiac lesion (arrow).
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Post chemotherapy PET CT scan shows minimal FDG uptake in left inguinal node (arrow) and disappearance of right inguinal nodes suggestive of partial response.
Figure 4
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Post chemotherapy PET CT scan shows minimal FDG uptake in left inguinal node (arrow) and disappearance of right inguinal nodes suggestive of partial response.

Patient was monitored with regular follow-up during chemotherapy course and was doing well. Subsequently, after 1 month of finishing six cycles of chemotherapy, patient developed abscess in the left inguinal node which was managed initially with antibiotics, but later required incision and drainage. The patient had prolonged hospital course and was discharged under satisfactory condition. Later, 1 month after discharge, the patient presented to the emergency department with dyspnea and chest pain. Investigation revealed massive pericardial effusion. Patient underwent drainage of pericardial effusion and biopsy of the pericardial tissue confirmed metastatic disease [Figure 5]. The patient showed partial improvement, but later succumbed to massive cardiac failure.

40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Histopathology slide of pericardial tissue stained with hematoxylin and eosin (10× magnification) shows islands and nest of cells surrounded by desmoplastic stroma (arrow) and immunopositivity with PAN – cytokeratin.
Figure 5
40–year-old male presented with a lesion over the glans penis diagnosed as carcinoma penis. Histopathology slide of pericardial tissue stained with hematoxylin and eosin (10× magnification) shows islands and nest of cells surrounded by desmoplastic stroma (arrow) and immunopositivity with PAN – cytokeratin.

DISCUSSION

Squamous cell carcinoma (SCC) of penis is a common genitourinary malignancy in Asia. It commonly presents in the elderly age group. Risk factors include uncircumcised state, smoking, and exposure to human papilloma virus. The usual sites of metastasis include the inguinal and pelvic lymph nodes and the liver, lungs, and bones. Intracardiac metastasis occurs rarely with most of the cases detected on autopsy. Cardiac metastases usually involve the pericardium and less commonly the myocardium.[3] The presentation may be arrhythmias, thromboembolic episodes, or in rare cases cardiac rupture, pericardial tamponade, and even sudden cardiac death. Treatment involves combination chemotherapy, although the effect of the currently available chemotherapy regimens is far from satisfactory.

In our patient, the cardiac lesion was incidentally detected on 18F-FDG PET-CT images and there was a partial response to combination chemotherapy. He remained asymptomatic for the cardiac lesion till the completion of chemotherapy. Our case is unique as it is one of the few cases of cardiac metastasis from a primary penile cancer detected while the patient was alive and where the patient showed a documented partial response to combination chemotherapy.

CONCLUSION

Cardiac metastasis is a rare occurrence in penile cancer and systemic chemotherapy remains the only therapeutic option, albeit with limited efficacy. We report a rare case of cardiac metastasis in carcinoma penis detected as an incidental finding on PET-CT. The need for systemic work-up is essential in patients with bulky nodal disease to rule out distant metastasis, as in our case. The treatment protocol and prognosis change in metastatic disease. FDG PET imaging has a role in staging work-up in patients with carcinoma of the penis. Prompt diagnosis and aggressive treatment are paramount in improving survival and quality of life.

ACKNOWLEDGMENT

The authors thank the patient's family for allowing them to publish the case report and use the images taken during his stay in hospital.

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES

  1. , . Metastasis of squamous cell carcinoma of the penis into the heart. Arkh Patol. 1998;60:59-61.
    [Google Scholar]
  2. , , , . Metastasis of penile cancer to the heart in a 20-year-oldpatient. Wiad Lek. 1992;45:314-6.
    [Google Scholar]
  3. , , , , . Cardiac metastases. J Clin Pathol. 2007;60:27-34.
    [Google Scholar]

Fulltext Views
5,124

PDF downloads
2,222
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections