We report a case of isolated penile metastasis from renal pelvic carcinoma in a 69-year-old man with malignant priapism. The patient had radical resection of the renal pelvic carcinoma 2 months earlier with urothelial carcinoma (UC) and sarcomatoid differentiation histology. Physical examination showed no visible skin lesions, but a palpable hard nodule was present over the penile shaft. The imaging studies did not reveal other metastases. Cavernous-Glans shunt and nodule resection were performed, and histological examination showed metastasis UC with sarcomatoid differentiation. To our knowledge, we describe the first case of malignant priapism due to isolated penile metastasis of renal pelvic carcinoma. Malignant priapism is prolonged penile erection without sexual stimuli, and is generally related to medical treatment, sickle cell disease, leukemia, polycythemia, penile metastasis of malignancies, pelvic thrombophlebitis and neurological diseases. 1 – 3 Metastasis to the penis mimicking priapism is extremely rare, particularly in the absence of disseminated disease. About 300 cases have been reported. 4 Primary sites include the bladder (33%), prostate (30%), colon (17%) and kidney (7%). 5 Extra-pelvic sites, including the lung, pancreas, stomach, esophagus, melanoma and testis, have been noted. 6 – 9 Fewer than 20 cases of penile metastasis from renal cancer have been reported, most of them were renal cell carcinoma in origin. 10 , 11 On the other hand, penile metastasis has been a part of more widespread disease in about 90% of reported cases. 12 We describe a case of malignant priapism caused by penile metastasis of renal pelvic carcinoma in the absence of radiological disseminated disease. There have been no previous reports of renal pelvic carcinoma without regional metastasis with only penis metastasis. This is the first case of a renal pelvic carcinoma with isolated metastasis to penis.
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