title: Priapism as a result of chronic myeloid leukemia: case report, pathology, and review of the literature.
abstract: BACKGROUND
  Priapism is rare-presenting feature in male patients with chronic myeloid leukemia (CML). Several hypotheses for pathogenesis have been described. Management has been controversial; some authors described resolution following priapism-specific interventions, and others recommended addition of CML-specific therapy or even CML-specific therapy alone.
  
  
  OBJECTIVE
  In this report, we describe presentation and management of a man with refractory priapism that was the first presenting manifestation of CML. We also report, for the first time, the pathology sections of the sinusoidal tissue in such cases. Literature is reviewed for similar cases and their outcome.
  
  
  METHODS
  A 21-year-old male patient presented with painful priapism that started 6 days earlier and failed aspiration-irrigation. CBC revealed marked leucocytosis. Oncology care diagnosed CML, and treatment with Imatinib was commenced with prior semen cryopreservation. Following remission, a penile prosthesis was implanted, assisted by optical corporotomy. Sinusoidal tissue biopsy was stained by hematoxylin/eosin (H&E) and CD34.
  
  
  METHODS
  Pathology sections of cavernous tissue following CML-induced priapism.
  
  
  RESULTS
  The penile implant survived without complications. H&E examination of the sinusoidal tissue biopsy revealed leukemic infiltration associated with vascular endothelial damage. CD34 staining showed the mixed picture of leukemic infiltrates, intact vascular endothelium with lumena showing leukemic cells, alternating with destroyed vessels, and no vascular lumena and ruminants of endothelial cells.
  
  
  CONCLUSIONS
  Priapism can be the first manifestation of previously undetected CML. The pathological picture of sinusoidal tissue in such cases is presented. In the case at hand, a complete blood picture was helpful in early diagnosis of CML and early initiation of targeted chemotherapy along with the corporal irrigation/aspiration or shunt surgery. It is therefore recommended to have a CBC examined at presentation of any case of ischemic priapism of unknown etiology, early initiation of CML therapy along with aspiration/irrigation, preferably cryopreserving a semen sample before CML therapy.
authors: Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Osama Kamal Zaki Mahmoud
authors: OK
authors: Shaeer
authors: Kamal Zaki Mahmoud
authors: KZ
authors: Shaeer
authors: Islam Fathy Soliman
authors: IF
authors: AbdelRahman
authors: Mostafa Shawky
authors: MS
authors: El-Haddad
authors: Osama Mohamed
authors: OM
authors: Selim
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D015925:Cryopreservation; D004730:Endothelium, Vascular / Q000473:pathology*; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D015917:Penile Prosthesis; D010879:Piperazines / Q000627:therapeutic use*; D011317:Priapism / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D011743:Pyrimidines / Q000627:therapeutic use*; D012662:Semen Preservation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
keywords: CML; Chronic Myeloid Leukemia; Priapism