Penile metastasis as a first sign of lung cancer - English

Sevket Ozkaya1, Serhat Findik 2, Atilla G Atici 2
1Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey;
2Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis
University, Kurupelit, Samsun, Turkey

Abstract: Lung cancer does not generally produce any symptoms at the early stages and it rapidly metastasizes. Although lung cancer has a potential of metastasis to all organs and tissues, metastasis to the penis from lung cancer is very rare. We present a case with a penile lesion as the first sign of lung cancer.

Keywords: lung cancer, metastasis, penis

Introduction
Lung cancer is currently the leading cause of cancer death throughout the world.
Lung cancer does not generally produce any symptoms at the early stages and it
rapidly metastasizes. Although lung cancer has a potential of metastasis to all organs and tissues, the main sites of metastases are bones, liver, brain, and adrenal glands. Although the penis has a very rich vascularization, metastasis to the penis is very rare. The penis is usually affected by local infiltration of carcinomas of adjacent organs such as prostate, rectum, colon, and bladder.
Penile metastasis of lung cancer has been rarely reported, that is, where all patients had been diagnosed with lung cancer before penile metastasis. To our knowledge, there is no paper reporting a penile lesion as a first sign of lung cancer.
Case report
A 55-year-old man was seen in the urology clinic of Samsun Chest Diseases and
Thoracic Surgery Hospital because of a painful lesion on his penis for three months. He also complained of effort dyspnea for two years. He denied fever, sputum production, malaise, and anorexia with weight loss. He was a retired officer. His medical history was noteworthy of a 35 pack-year smoking history and he was circumcised when he was seven years old. There were no other significant features in both his self-reported history and family history.
On physical examination, the patient appeared well. Vital signs were normal.
He had a barrel chest. There was a reduction of respiratory sounds on both lungs with hyperresonance on percussion and decreased tactile fremitus. Grade V finger clubbing was present. Urologic examination revealed an irregularly shaped, ulcerous lesion of 2 × 2.5 cm in diameter on the glans penis (Figure 1). The remainder of the findings from examination were within normal limits.
A chest roentgenogram demonstrated a solitary pulmonary nodule in the right
middle zone and bilateral hyperlucency with hyperinflation.