Clitoral priapism due to distant clitoral metastasis of high-grade serous ovarian carcinoma: A case report and review of the literature
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Abstract:
• Cutaneous metastasis at the initial presentation of ovarian carcinoma is rare. • Clitoral metastasis in a gynecological malignancy can occasionally present as clitoral priapism. • Clitoral priapism can be treated with oral or intramuscular alpha blockade.Keywords:
Priapism
Presentation (obstetrics)
Clitoris
To investigate the clinical characteristics of female clitoral priapism.A 29-year-old case of painful priapism of the clitoris lasting 60 hours was reported. The etiology, diagnosis and treatment of clitoral priapism were discussed and the literature reviewed.The patient was cured by intracavernous administration of adrenaline.Clitoral priapism is extraordinarily rare. It is primarily due to oral antidepressant drugs or pelvic malignant neoplasm which leads to tissue infiltration of the clitoral veins and obstruction of the clitoral corporeal blood flow. The efficient therapeutic approach to clitoral priapism is intracavernous administration of alpha-agonists similar to the treatment of penile priapism.
Priapism
Clitoris
Etiology
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Priapism is a urologic emergency defined as a prolonged, possibly painful, penile erection. There are several known causes of priapism including psychotropic medications. One of the mechanisms by which antipsychotics are believed to induce priapism is through alpha-1 antagonism. This is case of a 50-year-old male with a history of schizophrenia with previous priapism related to trazodone, who presents with new onset priapism associated with risperidone. In this case, the treatment of priapism includes discontinuation of the offending agent and drainage of the corpus cavernosum twice along with intracavernosal phenylephrine injections. It is important to educate patients on priapism as a possible side effect of medications. It is also important to consider previous episodes of medication-induced priapism when prescribing psychotropic medications as this may increase the patient’s future risk of priapism.
Priapism
Trazodone
Discontinuation
Psychotropic Agent
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Ascitic fluid
Pericardial fluid
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Abstract We aim to describe the management trends of patients suffering from any priapism, and to evaluate the risks of developing priapism after intracavernosal injections (ICI) performed in the office. We queried TriNetX for two separate male adult cohorts - those who presented with any priapism based on ICD code, N48.3 and those who underwent ICI in the office based on CPT code, 54235. We evaluated treatment options for these patients after any priapism and described demographic risks for developing priapism after ICI performed in office. There were 17,545 priapism encounters and 26,104 usages of ICI in the office. Most common treatment for any priapism was corporal irrigation/injection of medications. The prevalence of prosthesis implants for the acute management of any priapism was low (0.33% malleable, 0.18% inflatable). Patients presenting with priapism after ICI were younger and had a disproportionate prevalence of mood disorders, pain disorders and sickle cell disease. They were less likely to have diabetes, hypertension, prostate cancer or have taken sildenafil or tadalafil. Despite increased exposure, the utility of penile prosthesis placement after priapism remains low. For patients administered and prescribed ICI, proper screening and counseling of developing priapism is important to reduce complications such as erectile dysfunction.
Priapism
Penile prosthesis
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In Brief The clitoris may become involved by vulvar lesions. There are also lesions arising from the clitoris. A familiarity with these lesions is necessary for the high index of suspicion needed for their diagnosis. Lesions of the clitoris are reviewed.
Clitoris
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Priapism
Clitoris
Penile Diseases
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3-Phosphoinositide-dependent protein kinase-1 (PDK1) mediates the cellular effects of various growth factors. Increased PDK1 expression is present in various cancers, suggesting that PDK1 may be a critical oncogene in cancer progression. However, only limited data exist on PDK1 expression in ovarian serous cancer.We used tissue microarrays to analyze PDK1 expression in 253 primary ovarian serous carcinoma samples.A statistically significant negative correlation between PDK1 expression and tumor grade was found. In the high-grade group of ovarian serous carcinomas (n=189), there was a statistically significant difference in overall survival between cases with positive and negative PDK1 expression (p=0.035); positive cases showed longer overall survival. Multivariate analysis confirmed that slight PDK1 expression was an independent indicator for prolonged overall survival (HR=0.51, 95% CI=0.28-0.92, p=0.025).PDK1 appears to be a prognostic marker and a possible therapeutic target in ovarian serous carcinoma.
Serous carcinoma
Tissue microarray
Serous ovarian cancer
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Priapism
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Purpose: The frequency of priapism is very high in adult sickle cell patients. In Africa, the assessment of the level of knowledge of priapism in sickle cell patients showed that priapism was poorly known. The objective of this study was to assess the knowledge, prevalence and clinical features of priapism in adult sickle cell patients in Senegal. Materials and methods: This was a seven-month descriptive study of 219 male patients with sickle cell disease (SS, SC, S-beta-thalassemia). SS sickle cell patients were in the majority. A questionnaire was drawn up with a 20-minute interview with each patient to assess his or her knowledge and the clinical features of priapism. Results: The mean age of the patients was 27.1 years (18-54) (SD=7.1). Twenty-three patients (10.5%) were aware of priapism (p=0.004). The prevalence of priapism in sickle cell patients was 41.5%. SS sickle cell patients were at higher risk (91.2%). Eighty-five patients (93.4%) had at least one episode of intermittent priapism and 24 patients (26.4%) had acute priapism. The mean age of onset of the first episode of priapism was 20.4 years +/- 6.1 years. The majority of patients (62.5%) had consulted within the first 24 hours. The last episode of priapism in 50.5% of patients was more than 6 months ago. Priapism occurred at night during sleep in 92.3% of patients. Fifty-eight patients (63.7%) did not have any factors favouring the occurrence of priapism. Conclusion: Priapism is a frequent serious vaso-occlusive complication in sickle cell disease. We show in this study, a high prevalence, the lack of knowledge of priapism and the clinical particularities of priapism in sickle cell disease in Senegal. The authors do not declare any conflict of interest
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Low-grade serous ovarian carcinoma and its high-grade serous ovarian carcinoma counterpart differ in their precursor lesions, molecular profile, natural history, and response to therapies. As such, low-grade serous ovarian carcinoma needs to be studied separately from high-grade serous ovarian carcinoma, despite challenges stemming from its rarity. A deeper understanding of the pathogenesis of low-grade serous ovarian carcinoma and the most common molecular defects and pathways involved in the carcinogenesis of the ovarian epithelium from normal to serous borderline ovarian tumors to low-grade serous ovarian carcinoma will help develop better therapies. By adopting targeted approaches there may be an opportunity to integrate novel therapies without the need for robust numbers in clinical trials. This manuscript will discuss low-grade serous ovarian carcinoma and focus on the arising treatments being developed with an improved understanding of the pathogenesis of this disease.
Serous carcinoma
Cystadenocarcinoma
Targeted Therapy
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