British Journal of Radiology (2006) 79, 526-528
© 2006 British Institute of Radiology
doi: 10.1259/bjr/55555394
MR findings of penile lymphoma
K-H Chiang, MD,
P-Y Chang, MD,
S-K Lee, MD,
P-S Yen, MD,
C-M Ling, MD,
C-C Lin, MD,
C-C Lee, MD and
A S-B Chou, MD
Department of Radiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;
Correspondence: Dr Andy Shau-Bin Chou, Department of Radiology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
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Abstract
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Penile lymphoma is extremely rare and secondary involvement of the penis by lymphoma may be due to retrograde spread or to direct extension from neighbouring organ. The appearance of penile lymphoma varies and can be mistaken for other soft tissue tumours. We report on a case with malignant lymphoma of the penis. MRI findings revealed soft-tissue mass of homogeneous isointensity around the middle to distal part of penis on T1 weighted imaging and T2 weighted imaging. It was well encapsulated, minimally enhanced and distinct from corpus cavernosum and corpus spongiosum.
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Introduction
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Penile lymphoma is an extremely rare neoplasm. Nodules, ulcers and diffuse penile swelling have been reported as the presentation of penile lymphoma, and the penile shaft is the most common site of involvement [1–4]. Full physical examination and radiological image investigations, including CT, MRI and PET (positron emission tomography), should be undertaken to stage the patient. Chemotherapy has the advantage of treating both the primary lesion and any systemic disease. Herein, we report on a case with malignant lymphoma of the penis and its imaging findings.
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Case report
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A 77-year-old man presented with a more than 2-week history of a painless mass at penile base. He denied sexual exposure, previous sexually transmitted diseases, recent trauma and underlying medical disease. No difficulty with urination had been experienced. There was no fever, night sweats, fatigue or body weight loss in the previous 6 months.
Physical examination revealed a firm nodule at penile base. The remainder of his physical examination was uneventful. Haematological and chemical panel values were within normal limits except elevated prostate specific antigen (PSA) and lactic acid dehydrogenase (LDH) (PSA: 23.0 ng ml–1, normal range: 0–4 ng ml–1; LDH: 751 IU l–1, normal range: 15–400 IU l–1).
Pelvic MRI without and with Gd-DTPA enhancement was performed by a 1.5-Tesla MR scanner (Signa Excite; GE Medical System, Milwaukee, WI). The study showed soft-tissue mass of homogeneous isointensity around the middle to basal part of penis on T1 weighted and T2 weighted images. It was well capsulated, minimally enhanced by contrast medium, and distinct from both the corpus cavernosum and corpus spongiosum (Figure 1
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Figure 1. (a) Axial T1 weighted image (repetition time (TR)/echo time (TE) = 467/8) showed soft-tissue mass of homogeneous isointensity around the middle to basal part of penis. (b) Sagittal T2 weighted image (TR/TE = 2350/87) showed the extension of the lesion. The capsule of corpus spongiosum is intact. (c) Coronal T1 weighted image (TR/TE = 2650/87) showed the relationship between the mass and the corpus cavernosum and corpus spongiosum. (d) Coronal T1 weighted image after Gd-DTPA demonstrated the mass without obvious enhancement.
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Cystoscopy with transrectal needle biopsy of prostate and scrotal incisional biopsy revealed a picture of large B-cell lymphoma, but there was no obvious abnormal finding of prostate while reviewing the MR images. CT of the chest, abdomen and pelvis showed only the penile mass (Figure 2) and bone marrow biopsy was negative. He underwent six courses of systemic chemotherapy with a CHOP regimen and tolerated the whole course of chemotherapy well. The penile mass disappeared gradually after six cycles of chemotherapy. At regular follow-up evaluations, the patient is free from recurrence and dissemination 8 months after the diagnosis.
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Figure 2. Contrast-enhanced CT showed soft-tissue mass of homogeneous isodense around the basal part of penis. There is also no obvious enhancement of the mass.
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Discussion
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Penile lymphoma is extremely rare and secondary involvement of the penis by lymphoma may be due to retrograde spread (haematic or lymphatic) or to direct extension from neighbouring organ [1–3, 5]. The most commonly affected site was the shaft, followed by the glans penis [6]. Diffuse large cell lymphoma was the most common histological subtype [7].
The appearance of penile lymphoma varies: it may appear as a mass, as plaques or ulcers in the skin of the organ, or as diffuse penile swelling [8]. Full physical examination and radiological image investigation, including CT, MRI and PET, should be undertaken to stage the patient [4]. Excision biopsy is essential to achieve the correct diagnosis, and histological analysis must include immunohistochemical tests to differentiate lymphoma from undifferentiated sarcomas or carcinomas and to distinguish between B- and T-cell lymphomas [7].
As in our case, MRI provides better tissue-contrast than CT. The margins between the mass and corpus cavernosum and corpus spongiosum are clear. MRI images of penile lymphoma had not been documented. It should be homogeneous isointensity on T1 weighted and T2 weighted images and minimally enhanced by contrast medium.
Lymphoma of the penis seems to behave in a less aggressive pattern [9]. Chemotherapy has the clear advantage of obtaining good cosmetic and functional results; it will also be effective in patients with occult disseminated lymphomas [10]. Radical surgery should be used only after the failure of other modalities [7].
In conclusion, penile lymphoma is extremely rare and can be mistaken for other soft tissue tumours. The possibility of this diagnosis should be considered when evaluating a nodule or mass in the penis. MRI may play a role in the pre-treatment evaluation of penile lymphoma for local tumour involvement.
Received for publication March 8, 2005.
Revision received May 9, 2005.
Accepted for publication May 23, 2005.
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References
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Abstract
Introduction
