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LETTER TO THE EDITOR
Year : 2018  |  Volume : 14  |  Issue : 6  |  Page : 1442-1443

Priapism as a rare presentation of chronic myeloid leukemia


Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India

Date of Web Publication28-Nov-2018

Correspondence Address:
Khaliqur Rahman
Department of Hematology, SGPGI, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.199388

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How to cite this article:
Kumar P, Rahman K, Kumari S, Singh MK, Gupta R, Nityanand S. Priapism as a rare presentation of chronic myeloid leukemia. J Can Res Ther 2018;14:1442-3

How to cite this URL:
Kumar P, Rahman K, Kumari S, Singh MK, Gupta R, Nityanand S. Priapism as a rare presentation of chronic myeloid leukemia. J Can Res Ther [serial online] 2018 [cited 2020 Aug 13];14:1442-3. Available from: http://www.cancerjournal.net/text.asp?2018/14/6/1442/199388



Sir,

Priapism is persistent and painful erection of the penis without accompanied sexual arousal for more than 6 h.[1] In about 20% of the cases, priapism is due to some hematological causes and leukemia accounts for 1%–5% of priapism.[2]

We report three cases of chronic myeloid leukemia (CML) who presented with priapism as the first symptom. The clinicopathological profile is represented in [Table 1]. All the three patients presented to the emergency department with a history of the painful erection of penis for 5–7 days. They did not have any history of trauma or any other medication. Examination revealed rigid tender penile shaft with no mark of injury and a normal meatal opening. Other systemic examination showed the presence of splenomegaly in one, hepatosplenomegaly in other and no other abnormality in the third case. All of them were managed in the emergency department through aspiration and irrigation with phenylephrine and then winter's T shunt. The investigation revealed peripheral leukocytosis with shift to left, a hypercellular marrow with myeloid predominance and basophilia and a positive BCR-ABL transcript confirming the diagnosis of CML [Figure 1]. They were managed with hydrea initially, then switching to imatinib after the confirmation of BCR-ABL transcript report. All of them are on routine follow-up and are doing fine.
Table 1: Clinicopathological profile of the patients

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Figure 1: Microphotograph of peripheral blood showing leukocytosis with shift to left and basophilia (a) MGG stain, ×10. Bone marrow aspiration shows hypercellular packed particle (b), the trails were cellular and showed maked myeloid proliferation with shift to left (c). Postpolymerase chain reaction gel electrophoresis showing a 347 base pair positive band of BCR-ABL p210 product, confirming the case as chronic myeloid leukemia (d)

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Leukocytosis associated with leukemia causes stasis of venous blood and leads to “Low Flow” type of priapism also known as ischemic or anoxic priapism.[3] Leukemia accounts for approximately 1%–5% of priapism. Of this, CML accounts for 50% of the cases. However, priapism as a presenting feature of CML is rare and is noted in 1%–2% of CML patients.[4] Over the last 4 years, a total of 416 new cases of CML were diagnosed at our institute, of which only 3 (0.74%) cases presented with priapism. Priapism is a medical emergency because irreversible cell damage and fibrosis can occur if not treated within 24–48 h. First-line treatment is aspiration of blood from corpora cavernosa. The success rate with aspiration alone is approximately 30%. If the treatment is unsuccessful, instillation of the sympathomimetic agent phenylephrine hydrochloride every 5 min is used until the swelling of the penis is reduced or subsided. If conservative management fails then surgery (shunt procedure) can be considered.[5] The underlying leukemic cause like CML should be treated simultaneously as well with cytoreductive therapy. In conclusion, priapism can be a rare presentation of CML. Hence, a complete blood count with peripheral blood examination should be carried out in the primary workup of priapism.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Keoghane SR, Sullivan ME, Miller MA. The aetiology, pathogenesis and management of priapism. BJU Int 2002;90:149-54.  Back to cited text no. 1
    
2.
Burnett AL. Therapy insight: Priapism associated with hematologic dyscrasias. Nat Clin Pract Urol 2005;2:449-56.  Back to cited text no. 2
    
3.
Liguori G, Bucci S, Benvenuto S, Trombetta C, Belgrano E. Priapism: Pathophysiology and management. J Androl Sci 2009;16:13-20.  Back to cited text no. 3
    
4.
Broderick GA. Priapism. In: Wein AJ, editor. Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier-Saunders; 2012. p. 749-69.  Back to cited text no. 4
    
5.
Cherian J, Rao AR, Thwaini A, Kapasi F, Shergill IS, Samman R. Medical and surgical management of priapism. Postgrad Med J 2006;82:89-94.  Back to cited text no. 5
    


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