{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:01:03Z","timestamp":1790006463067,"version":"4.0.1"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Malignant priapism is a rare manifestation of advanced malignancy caused by malignant infiltration of the corpora cavernosa. We report a case of persistent and refractory priapism associated with penile carcinoma and extensive metastatic disease, with a suspected pulmonary primary. Case Presentation: An 81-year-old man with a history of prostate cancer treated by radical prostatectomy and persistently undetectable PSA levels developed persistent low-flow priapism. Despite aspiration and irrigation, followed by distal and proximal shunting procedures, the condition recurred with progressive corporal induration and severe pain. Cavernous biopsy was initially interpreted as moderately differentiated squamous carcinoma, while total penectomy performed for refractory pain showed poorly differentiated carcinoma with morphological adenosquamous features. CT and PET\/CT demonstrated a pulmonary mass and widespread metastatic disease, although bronchoscopy was non-diagnostic and no histological confirmation of the pulmonary lesion was obtained. A focused review of the literature identified 32 published cases of malignant priapism; bladder cancer was the most frequently reported primary malignancy (37.5%), followed by prostate cancer (18.8%) and renal cell carcinoma (9.4%), while penectomy was performed in 34.4% of cases. Conclusions: Persistent or recurrent priapism associated with corporal induration, progressive or atypical pain, failure of conventional treatment, or discordant imaging findings should raise suspicion of malignant infiltration and prompt consideration of repeat imaging and tissue sampling. In the present case, carcinoma involving the penile structures was histologically confirmed, whereas pulmonary origin remained a clinicoradiological suspicion; penectomy provided immediate pain relief in the setting of extensive refractory local disease.<\/jats:p>","DOI":"10.3390\/reports9030317","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:12:09Z","timestamp":1789999929000},"page":"317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Malignant Priapism as the Sole Initial Manifestation of Metastatic Carcinoma with Suspected Pulmonary Origin: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1139-6825","authenticated-orcid":false,"given":"Sara","family":"Riolo","sequence":"first","affiliation":[{"name":"Department of Urology, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Brunello","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agostino","family":"Fraia","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Papi","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Knez","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardino","family":"De Concilio","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8195-7784","authenticated-orcid":false,"given":"Tommaso","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Di Giulio","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Zeccolini","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Celia","sequence":"additional","affiliation":[{"name":"Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref_1","first-page":"1692706","article-title":"Metastasis-Induced Priapism as the First Sign of Lung Cancer: A Case Report and Review of the Literature","volume":"2024","author":"Nadalin","year":"2024","journal-title":"Case Rep. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/his.14927","article-title":"Metastatic solid tumours to the penis: A clinicopathologic evaluation of 109 cases from an international collaboration","volume":"83","author":"Collins","year":"2023","journal-title":"Histopathology"},{"key":"ref_3","first-page":"143","article-title":"Malignant priapism due to secondary carcinoma in the corpora cavernosum","volume":"37","author":"Peacock","year":"1938","journal-title":"Northwest Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2923","DOI":"10.18632\/oncotarget.23366","article-title":"Prognosis of men with penile metastasis and malignant priapism: A systematic review","volume":"9","author":"Cocci","year":"2017","journal-title":"Oncotarget"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.4081\/aiua.2016.2.150","article-title":"Malignant priapism due to penile metastases: Case series and literature review","volume":"88","author":"Zacharakis","year":"2016","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_6","first-page":"646","article-title":"The Diagnosis and Treatment of Penile Cancer","volume":"115","author":"Hakenberg","year":"2018","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4829","DOI":"10.2147\/OTT.S164574","article-title":"Adenosquamous carcinoma of the lung","volume":"11","author":"Li","year":"2018","journal-title":"Onco Targets Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5912","DOI":"10.1038\/s41598-021-85300-8","article-title":"Penile secondary lesions: A rare entity detected by PET\/CT","volume":"11","author":"Davidson","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0022-5347(17)67906-0","article-title":"Priapism due to unusual metastasis from bladder carcinoma: Case report","volume":"70","author":"Berard","year":"1953","journal-title":"J. Urol."},{"key":"ref_10","first-page":"205","article-title":"A clinical case of secondary tumor of the penis from the rectum, with malignant priapism","volume":"30","author":"Okumura","year":"1984","journal-title":"Hinyokika Kiyo"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1038\/sj.ijir.3900342","article-title":"Malignant priapism as the initial clinical manifestation of metastatic renal cell carcinoma with invasion of both corpora cavernosum and spongiosum","volume":"10","author":"Nezu","year":"1998","journal-title":"Int. J. Impot. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/S0090-4295(97)00607-9","article-title":"High flow malignant priapism with isolated metastasis to the corpora cavernosa","volume":"51","author":"Dubocq","year":"1998","journal-title":"Urology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/(SICI)1096-9098(199805)68:1<51::AID-JSO11>3.0.CO;2-U","article-title":"Priapism secondary to penile metastasis: A report of two cases and a review of the literature","volume":"68","author":"Chan","year":"1998","journal-title":"J. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1159\/000056584","article-title":"Malignant priapism associated with metastatic urethral carcinoma","volume":"66","author":"Hettiarachchi","year":"2001","journal-title":"Urol. Int."},{"key":"ref_15","first-page":"48","article-title":"Lesioni metastatiche peniene secondarie a carcinoma a cellule transizionali della vescica: Rara causa di \u201cpriapismo maligno\u201d [Metastatic penile lesions secondary to transitional cell carcinoma of the bladder: A rare cause of \u201cmalignant priapism\u201d]","volume":"74","author":"Casoli","year":"2002","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/S0210-4806(04)73164-2","article-title":"Carcinoma transicional y priapismo metast\u00e1tico [Transitional carcinoma and malignant priapism]","volume":"28","year":"2004","journal-title":"Actas Urol. Esp."},{"key":"ref_17","first-page":"639","article-title":"A rare case of penile metastasis of testicular cancer presented with priapism","volume":"51","author":"Inamoto","year":"2005","journal-title":"Hinyokika Kiyo"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/S0210-4806(08)73924-X","article-title":"Priapismo secundario a infiltraci\u00f3n peneana por contig\u00fcidad de carcinoma vesical infiltrante [Priapism secondary to penis infiltration of bladder cancer]","volume":"32","year":"2008","journal-title":"Actas Urol. Esp."},{"key":"ref_19","first-page":"1839","article-title":"Malignant priapism secondary to testicular tumor","volume":"122","author":"Jiang","year":"2009","journal-title":"Chin. Med. J."},{"key":"ref_20","first-page":"149","article-title":"A case of penile metastasis of malignant melanoma with priapism","volume":"55","author":"Okinami","year":"2009","journal-title":"Hinyokika Kiyo"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4209","DOI":"10.3748\/wjg.15.4209","article-title":"Priapism secondary to penile metastasis of rectal cancer","volume":"15","author":"Park","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7281","DOI":"10.4076\/1757-1626-2-7281","article-title":"Early penile metastasis from primary bladder cancer as the first systemic manifestation: A case report","volume":"2","author":"Arisan","year":"2009","journal-title":"Cases J."},{"key":"ref_23","first-page":"239","article-title":"Priapismo maligno secundario a c\u00e1ncer de vejiga [Malignant priapism and secondary bladder cancer]","volume":"62","year":"2009","journal-title":"Arch. Esp. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3518","DOI":"10.1111\/j.1743-6109.2009.01577.x","article-title":"High-flow priapism due to a malignant glomus tumor (glomangiosarcoma) of the corpus cavernosum","volume":"8","author":"Rocher","year":"2011","journal-title":"J. Sex. Med."},{"key":"ref_25","first-page":"90","article-title":"Malignant priapism secondary to metastatic prostate cancer: A case report and review of literature","volume":"13","author":"Lin","year":"2011","journal-title":"Rev. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s11845-010-0608-x","article-title":"Malignant priapism: A case report","volume":"180","author":"Ellanti","year":"2011","journal-title":"Ir. J. Med. Sci."},{"key":"ref_27","first-page":"14","article-title":"Case of malignant priapism and review of the literature","volume":"95","author":"Ahmed","year":"2012","journal-title":"Med. Health Rhode Isl."},{"key":"ref_28","first-page":"549","article-title":"Malignant priapism due to metastatic papillary renal cell carcinoma: A case report","volume":"58","author":"Mochizuki","year":"2012","journal-title":"Hinyokika Kiyo"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1097\/RLU.0b013e31824c7604","article-title":"18F-FDG PET\/CT in a case of malignant priapism secondary to metastasis from mucoid adenocarcinoma of the cecum","volume":"38","author":"Sasikumar","year":"2013","journal-title":"Clin. Nucl. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.21037\/tau-23-327","article-title":"Malignant priapism: Case report and update on management protocols","volume":"12","author":"Tabei","year":"2023","journal-title":"Transl. Androl. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"FSO611","DOI":"10.2144\/fsoa-2020-0047","article-title":"Early penile-only metastasis of urothelial bladder carcinoma","volume":"6","author":"Tayeh","year":"2020","journal-title":"Future Sci. OA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e43622","DOI":"10.1097\/MD.0000000000043622","article-title":"A rare case of penile metastasis from renal cell carcinoma following combination therapy with immune checkpoint and tyrosine-kinase inhibitors: A case report and literature review","volume":"104","author":"Arai","year":"2025","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Xu, M., Shang, M., Liu, Z., Yang, L., and Yu, D. (2025). Case report: Malignant priapism: Penile metastasis from prostate cancer with low serum PSA level. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1395301"},{"key":"ref_34","first-page":"e80222","article-title":"Malignant priapism, an ominous sign with dismal prognosis: A case report","volume":"17","author":"Ravichandran","year":"2025","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1159\/000472818","article-title":"Mixed carcinoma of the prostate with penile metastases and priapism","volume":"13","author":"Savion","year":"1987","journal-title":"Eur. Urol."},{"key":"ref_36","first-page":"321","article-title":"Transitional cell carcinoma of the prostate metastatic to penis as cause of priapism","volume":"43","year":"1990","journal-title":"Arch. Esp. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.4081\/oncol.2012.e10","article-title":"A review of penile metastasis","volume":"6","author":"Mearini","year":"2012","journal-title":"Oncol. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e7307","DOI":"10.1097\/MD.0000000000007307","article-title":"Penile metastases from primary lung cancer: Case report and literature review","volume":"96","author":"Guo","year":"2017","journal-title":"Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/1752-1947-6-252","article-title":"Pulmonary adenocarcinoma presenting with penile metastasis: A case report","volume":"6","author":"Karanikas","year":"2012","journal-title":"J. Med. Case Rep."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:07:47Z","timestamp":1790003267000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030317"],"URL":"https:\/\/doi.org\/10.3390\/reports9030317","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}