源自食道鱗狀細胞癌的陰莖轉移：罕見病例報告

鄭鼎耀、蔡維恭

馬偕紀念醫院 泌尿科

Penile Metastasis from Esophageal Squamous Cell Carcinoma: A Rare Case Report

Ting-Yao Cheng, Wei-Kung Tsai

Department of Urology, Mackay Memorial Hospital

Case Presentation

A 60-year-old male with an extensive history of stage IIIB esophageal squamous cell carcinoma (SCC), originally managed through a comprehensive approach including VATS esophagectomy, chemotherapy, and chemoradiotherapy, later developed penile metastasis, a rare and ominous sign of advanced disease. The manifestation of his penile metastasis was particularly marked by significant penile pain and the palpation of firm nodules over the bilateral corpus cavernosum, prompting further investigation. A biopsy of the penile tunica albuginea conducted in November 2022 confirmed metastatic squamous cell carcinoma, establishing a direct link to his primary esophageal cancer. This complication led to obstructive uropathy, necessitating Foley catheter insertion, and was compounded by cachexia, severe anemia, and a constellation of other systemic issues reflective of his deteriorated condition.

Discussion

The occurrence of penile metastasis from esophageal SCC is exceptionally rare, with the literature suggesting it represents less than 1% of all penile tumor cases . This rarity underscores the aggressive nature of such metastatic spread and heralds a particularly poor prognosis. In cases where penile metastasis is diagnosed, the median survival time post-diagnosis is often reported as less than 6 months, reflecting the advanced stage of the underlying cancer and the systemic involvement at the time of detection .

Symptoms of penile metastasis, such as pain, the presence of palpable nodules, and urinary obstruction, significantly affect the patient's quality of life and are indicative of a need for palliative care measures. Management strategies for penile metastasis primarily focus on symptom relief, with options including analgesics for pain, surgical intervention for obstructive symptoms, and local radiation therapy for tumor mass reduction. However, given the advanced nature of the disease, these interventions are palliative, aiming to improve quality of life rather than cure the disease.

This case exemplifies the severe implications of penile metastasis from esophageal SCC, a manifestation that is not only rare but also significantly detrimental to the patient's well-being and prognosis. It accentuates the importance of a multidisciplinary approach in the palliative care of patients with such advanced and complex cancer presentations. The limited survival prognosis following the diagnosis of penile metastasis highlights the urgent need for ongoing research into early detection methods, understanding the mechanisms of metastatic spread, and developing novel therapeutic strategies aimed at improving outcomes for patients with advanced cancer. Further, this case contributes to the scant literature on the subject, providing insight and awareness into a highly aggressive and terminal aspect of cancer metastasis.