PMC5892242_01
Axial T1-weighted MR images (a) demonstrate two isointense penile masses involving the left paracentral shaft base and proximal right corpus cavernosum (solid arrows) demonstrated with enhancement (solid arrow) on axial contrast enhanced T1-weighted MR images (b). The larger lesion at the base of the shaft demonstrates peripheral enhancement and central nonenhancement (dashed arrow), while the smaller posterior lesion homogeneously enhances. Both lesions demonstrate intrinsic heterogeneous hyperintensity (solid arrow) on axial T2-weighted MR imaging (c). Corresponding to the areas of enhancement on postcontrast MR images, PET/CT imaging (d) demonstrates hypermetabolic activity (solid arrow). A central area of decreased metabolic activity within the larger lesion (dashed arrow) corresponds to the area of central nonenhancement on MRI in keeping with central necrosis. Coronal contrast-enhanced T1-weighted MR image (e) demonstrates the larger lesion (solid arrow) extending across the intercorporal septum (dashed arrow).
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fig1
TV x CC) irregularly shaped mass centered in the left corpus cavernosum involving the proximal and mid aspects of the penile shaft extending across the intercorporal septum (Figure 1). This lesion demonstrated intrinsic isointensity on T1-weighted images and hyperintensity on T2-weighted images with peripheral enhancement and central hypovascularity. Subsequent whole-body positron emission tomography/computed tomography (PET/CT) imaging demonstrated hypermetabolism of both penile lesions with a maximum standard uptake value (SUVmax) of 19.9 (Figures 1(d) and 3).
Immunohistochemical analysis of the penile mass demonstrates positive staining with an indicator for squamous cell carcinoma, p63 (a), and positive staining with an indicator for adenocarcinoma, mucicarmine (b). The small bowel mass demonstrates a similar immunostaining profile and is positive with both p63 (c) and mucicarmine (d) immunostains.
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fig2
TV) demonstrating similar T1 and T2 signal characteristics but with more homogeneous enhancement was present in the more proximal right corpus cavernosum. Transcoporeal biopsy of the larger penile lesion was performed and subsequent immunostaining was positive for squamous cell markers (p63 and CK5/6) as well as an adenocarcinoma marker (mucicarmine) in keeping with an ASC with a predominantly squamous cell pattern (Figures 2(a) and 2(b)). Immunostaining of the resected segment of small bowel demonstrated positive staining with p63 and mucicarmine strongly resembling the staining profile of the penile and subscapularis masses in keeping with metastatic spread to the small bowel (Figures 2(c) and 2(d)).
Axial T2-weighted FLAIR (a) and T1-weighted postcontrast MR images (b) demonstrate ring enhancing lesions in the bilateral parietal lobes (dashed arrows) at the level of the basal ganglia with surrounding vasogenic edema (solid arrows) in keeping with brain metastases.
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fig4
Subsequent contrast-enhanced MR imaging of the brain demonstrated multiple supratentorial and infratentorial ring enhancing lesions in keeping with metastases (Figure 4).