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T-Cell Lymphoma
Images in Clinical Urology Penile Metastasis Secondary to Nasal NK/T-Cell Lymphoma Shih-Kai Lan, Chih-Wen Lin, Hsu-Chueh Ho, Moon-Sing Lee, Jeh-En Tzeng, and Yu-Chieh Su We report on a case of recurrent nasal NK/T-cell lymphoma in a patient who presented with a penile mass. No obvious other recurrent site except the penile lesion was noted. Metastatic penile lymphoma is extremely rare. We describe the image findings and clinical course of this case. UROLOGY 72: 1014 –1015, 2008. © 2008 Elsevier Inc.
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48-year-old man was diagnosed in 2002 with nasal NK/T cell lymphoma. Six cycles of chemotherapy were administered, followed by local radiotherapy. The patient remained in complete remission until March 2007, when he noted a painful mass in his penile shaft. The physical examination revealed a well-defined, firm mass, lesion on the dorsum of the distal penile shaft. Penile ultrasonography revealed a 21.3 ⫻ 9.2-mm hypoechoic lesion in the right distal corpus cavernosum (Fig. 1). Pelvis magnetic resonance imaging revealed a mass in the distal portion of the right corpus cavernosum. The mass showed isointensity on the T1weighted images, and low-signal intensity on the T2weighted images (Fig. 2A,B). It showed a low-signal intensity on the T1-weighted contrast-enhanced fat suppression images (Fig. 2C). Incision biopsy of the tumor showed NK/T-cell lymphoma, consistent with the previous lymphoma. The penile mass lesion resolved after 4 cycles of salvage chemotherapy. Penile lymphoma is extremely rare.1 Only 1 case has been reported to be recurrent lymphoma.2 In the present case, the mass showed isointensity on the T1-weighted images and hypointensity on the T2-weighted images on
Figure 1. Longitudinal penile ultrasound scan showing hypoechoic mass with indistinct margins in right distal corpus cavernosum (arrows).
magnetic resonance imaging, in contrast to the findings of the previous report (isointensity on both T1- and T2-weighted images).3 References
From the Departments of Urology, Radiology, Otolaryngology, Radiation Oncology, Pathology, and Internal Medicine, Division of Hematology-Oncology, Buddhist Tzu Chi Dalin General Hospital, Chiayi, Taiwan Reprint requests: Yu-Chieh Su, M.D., Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Tzu Chi Dalin General Hospital, No. 2, Min Sheng Road, Dalin Town, Chiayi County, Taiwan, Republic of China. E-mail: [email protected] Submitted: May 7, 2008, accepted (with revisions): May 8, 2008
1014
© 2008 Elsevier Inc. All Rights Reserved
1. Lin DW, Thorning DR, Krieger JN. Primary penile lymphoma: Diagnostic difficulties and management options. Urology. 1999;54: 366-371. 2. Jabr FI. Recurrent lymphoma presenting as a penile ulcer in a patient with AIDS. Dermatol Online J. 2005;11:29. 3. Chiang KH, Chang PY, Lee SK, et al. MR findings of penile lymphoma. Br J Radiol. 2006;79:526-528.
0090-4295/08/$34.00 doi:10.1016/j.urology.2008.05.029
Figure 2. (A) Sagittal T1-weighted magnetic resonance imaging scan showing isointense mass in distal corpus cavernosum (arrow). (B) Axial T2-weighted magnetic resonance imaging scan showing ill-defined hypointense mass in right dorsal corpus cavernosum (arrow). (C) Sagittal T1-weighted fat suppression contrast-enhanced magnetic resonance imaging scan showing nonenhanced mass in distal corpus cavernosum (arrow).
UROLOGY 72 (5), 2008
1015
A
48-year-old man was diagnosed in 2002 with nasal NK/T cell lymphoma. Six cycles of chemotherapy were administered, followed by local radiotherapy. The patient remained in complete remission until March 2007, when he noted a painful mass in his penile shaft. The physical examination revealed a well-defined, firm mass, lesion on the dorsum of the distal penile shaft. Penile ultrasonography revealed a 21.3 ⫻ 9.2-mm hypoechoic lesion in the right distal corpus cavernosum (Fig. 1). Pelvis magnetic resonance imaging revealed a mass in the distal portion of the right corpus cavernosum. The mass showed isointensity on the T1weighted images, and low-signal intensity on the T2weighted images (Fig. 2A,B). It showed a low-signal intensity on the T1-weighted contrast-enhanced fat suppression images (Fig. 2C). Incision biopsy of the tumor showed NK/T-cell lymphoma, consistent with the previous lymphoma. The penile mass lesion resolved after 4 cycles of salvage chemotherapy. Penile lymphoma is extremely rare.1 Only 1 case has been reported to be recurrent lymphoma.2 In the present case, the mass showed isointensity on the T1-weighted images and hypointensity on the T2-weighted images on
Figure 1. Longitudinal penile ultrasound scan showing hypoechoic mass with indistinct margins in right distal corpus cavernosum (arrows).
magnetic resonance imaging, in contrast to the findings of the previous report (isointensity on both T1- and T2-weighted images).3 References
From the Departments of Urology, Radiology, Otolaryngology, Radiation Oncology, Pathology, and Internal Medicine, Division of Hematology-Oncology, Buddhist Tzu Chi Dalin General Hospital, Chiayi, Taiwan Reprint requests: Yu-Chieh Su, M.D., Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Tzu Chi Dalin General Hospital, No. 2, Min Sheng Road, Dalin Town, Chiayi County, Taiwan, Republic of China. E-mail: [email protected] Submitted: May 7, 2008, accepted (with revisions): May 8, 2008
1014
© 2008 Elsevier Inc. All Rights Reserved
1. Lin DW, Thorning DR, Krieger JN. Primary penile lymphoma: Diagnostic difficulties and management options. Urology. 1999;54: 366-371. 2. Jabr FI. Recurrent lymphoma presenting as a penile ulcer in a patient with AIDS. Dermatol Online J. 2005;11:29. 3. Chiang KH, Chang PY, Lee SK, et al. MR findings of penile lymphoma. Br J Radiol. 2006;79:526-528.
0090-4295/08/$34.00 doi:10.1016/j.urology.2008.05.029
Figure 2. (A) Sagittal T1-weighted magnetic resonance imaging scan showing isointense mass in distal corpus cavernosum (arrow). (B) Axial T2-weighted magnetic resonance imaging scan showing ill-defined hypointense mass in right dorsal corpus cavernosum (arrow). (C) Sagittal T1-weighted fat suppression contrast-enhanced magnetic resonance imaging scan showing nonenhanced mass in distal corpus cavernosum (arrow).
UROLOGY 72 (5), 2008
1015