| HISTOLOGICAL TYPES |
CHARACTERIZATION |
| General |
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| VARIANTS |
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| FIBROEPITHELIAL POLYP |
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Lymphedematous fibroepithelial polyps of the glans penis and prepuce: a clinicopathologic study of 7 cases demonstrating a strong association with chronic condom catheter use.
Fetsch JF, Davis CJ Jr, Hallman JR, Chung LS, Lupton GP, Sesterhenn IA.
Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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| Hum Pathol. 2004 Feb;35(2):190-5. Abstract quote |
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This report describes an underrecognized entity of the penis that is associated with chronic condom catheter use and phimosis. Our study group consisted of 7 patients who presented with polypoid or cauliflower-like masses that involved the glans penis or prepuce and that ranged in size from 2 to 7.5 cm in greatest dimension (median size, 2.5 cm). The majority of lesions affected the ventral surface of the glans, near the urethral meatus.
The patients ranged in age from 25 to 58 years (median age, 40 years) at the time of initial surgical resection. The preoperative duration of the lesions ranged from 6 months to 10 years. Five patients had a history of long-term condom catheter use (duration: 5 to 21 years), and 1 patient had paraphimosis. The background history for 1 patient is unknown. Histologically, all specimens had a polypoid configuration and a keratinizing squamous epithelial surface. The underlying stroma was notably edematous, and there was vascular dilation of preexisting vessels, and in many instances, a focal mild small vessel proliferation. The stroma had mildly to moderately increased cellularity with mononucleated and multinucleated mesenchymal cells. A mild inflammatory infiltrate was often present. Two cases were examined with immunohistochemistry, and the stromal cells had limited immunoreactivity for muscle-specific actin, alpha-smooth muscle actin, and desmin and had no reactivity for S100 protein or CD34. Surgical intervention was local in all instances.
Follow-up information was available for 5 of the 7 patients (71%), with a mean follow-up interval of 11 years 4 months. Two patients developed a local recurrence of the process at intervals of less than 1 years and 3 years 7 months. Both recurrent lesions were also managed by local excision. |
| GRANULOMATOUS LYMPHANGITIS |
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| Granulomatous lymphangitis of the scrotum and penis Report of
a case and review of the literature of genital swelling with sarcoidal
granulomatous inflammation
Michael J. Murphy1, Barry Kogan2 and J. Andrew Carlson3 1
Department of Dermatology, University of Connecticut Health Center,
Farmington, Connecticut, USA,2 Division of Urology, Albany Medical College,
Albany, New York, USA,3 Divisions of Dermatology and Dermatopathology,
Albany Medical College, Albany, New York, USA |
Journal of Cutaneous Pathology 2001;28 (8), 419-424 Abstract quote
Background: Acquired lymphedema of the genitalia is a rare childhood
presentation and is more common in elderly individuals secondary to
pelvic/abdomenal malignancy or its therapy or worldwide due to filariasis.
Objective: Herein, we report a case of a healthy 11-year-old boy who
presented with a 1-year history of chronic, asymptomatic scrotal and
penile swelling.
Biopsy revealed edema, lymphangiectases and peri- and intralymphatic
sarcoidal type granulomas. This histologic pattern of granulomatous
lymphangitis is most commonly associated with orofacial granulomatosis
(granulomatous cheilitis and Melkersson-Rosenthal syndrome) and Crohn’s
disease. Treatment with topical steroids and physical support has resulted
in marked improvement. No systemic disease (Crohn’s disease) is evident
1 year later. Literature review revealed 44 cases of genital lymphedema
with non-infectious granulomas. The majority of these young patients
had Crohn’s disease, frequently with anal involvement and a minority,
both with and without Crohn’s disease, had orofacial granulomatosis.
Conclusions: Granulomatous lymphangitis should be considered in the
differential diagnosis of chronic idiopathic swelling of the genitalia,
particularly in younger individuals. Further clinical examination, additional
laboratory studies and close follow-up for co-existing or subsequent
development of Crohn’s disease should be performed. The overlap between
granulomatous lymphangitis of the genitalia, Crohn’s disease and orofacial
granulomatosis suggest that granulomatous lymphangitis of the genitalia
may represent a forme fruste of Crohn’s disease. |
| MEDIAN RAPHE CYST |
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| Median Raphe Cyst of the Penis A Report of Two Cases with Immunohistochemical
Investigation
Mario Dini, M.D.; Gianna Baroni, B.Sc.; Maurizio Colafranceschi,
M.D.
From the Department of Plastic Surgery (M.D.) and the Department
of Human Pathology and Oncology (G.B., M.C.), University of Florence,
Florence, Italy. |
Am J Dermatopathol 2001;23:320-324 Abstract quote
Penile median raphe cysts are uncommon benign lesions occurring predominantly
in the ventral aspect of the glans penis of young men.
We observed two cases: those of a 67-year-old patient and a 22-year-old
patient. The epithelial lining of the cysts was composed of pluristratified
small cells that focally showed rows of columnar cells above the inner
surface as well as a monolayered mucinous columnar epithelium. A columnar
cell lining predominated in the younger patient. The cytokeratin (CK)
immunostaining pattern of the two cysts (CK7+++, CK13+++, CK20–, CAM
5.2+ ) supports the interpretation of a columnar mucinous epithelium
undergoing immature urothelial metaplasia. Carcinoembryonic antigen
immunostaining positivity of the columnar cells is probably related
to the dysembryogenetic cloacal nature of the cysts. Neuroendocrine
differentiation of sparse cells interspersed in the pluristratified
epithelium was documented by immunohistochemical staining for chromogranin
and synaptophysin. Cilia were not identified in the columnar cells by
light microscopy or by antidynein immunohistochemistry. |
| PARAFFINOMA |
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| Penile paraffinoma: Self-injection with mineral oil
Joel L. Cohen, MD
Charles M. Keoleian, MD
Edward A. Krull, MD
Detroit, Michigan |
J Am Acad Dermatol 2001;45:S222-4 Abstract quote
We present a 64-year-old patient with a 9-cm firm, irregular penile
mass associated with phimosis, erectile dysfunction, and voiding difficulty.
After he reluctantly admitted to multiple penile mineral oil self-injections
for enlargement, surgical excision was performed. Pathologic examination
was consistent with mineral oil granuloma (paraffinoma). Within several
weeks after surgery, his erectile dysfunction and voiding complaints
resolved. Paraffinomas have been encountered with the use of various
oily substances injected for cosmetic purposes. Despite early warnings,
these agents continued to be used to treat conditions ranging from hemorrhoids
to wrinkles and even baldness. Fortunately, most of these fads have
been abandoned by medical professionals, but the complicating lesions
have been documented as having lag times as long as 30 years. Complete
surgical excision remains the treatment of choice to prevent recurrence.
Increased public awareness is needed for the prevention of this physically
and psychologically debilitating problem. |
| PEARLY PENILE PAPULES |
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Pearly penile papules: still no reason for uneasiness.
Hogewoning CJ, Bleeker MC, van den Brule AJ, Voorhorst FJ,
van Andel RE, Risse EK, Starink TM, Meijer CJ.
Department of Gynecology and Obstetrics, Albert Schweitzer
Hospital, The Netherlands.
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J Am Acad Dermatol. 2003 Jul;49(1):50-4. Abstract quote BACKGROUND:
Penile lesions and pearly penile papules (PPP) are frequently found
in male sexual partners of women with cervical intraepithelial neoplasia
(CIN). The former have been associated with human papillomavirus (HPV).
OBJECTIVES: We estimated the prevalence of PPP in male sexual partners
of women with CIN, and investigated the association between PPP and
flat and papular penile lesions found in these men. We further evaluated
a possible association between PPP and HPV, age, and CIN grade of the
female partner.
METHODS: We evaluated by penoscopy the presence of HPV-associated penile
lesions and PPP in 226 male sexual partners of women with CIN. HPV was
tested by polymerase chain reaction-enzyme immunoassay and in situ hybridization.
RESULTS: The prevalence of PPP was 34% and was not associated with the
presence of penile lesions or a positive HPV test. Age and CIN grade
of the female partner were not related to the presence of PPP.
CONCLUSION: The prevalence of PPP in male sexual partners of women with
CIN is comparable with the prevalence described in men of more diverse
populations. Our data do not support a causative role for HPV in the
genesis of PPP.
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| ZOON'S BALANITIS |
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Balanitis of zoon: a clinicopathologic study of 45 cases.
Weyers W, Ende Y, Schalla W, Diaz-Cascajo C.
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Am J Dermatopathol 2002 Dec;24(6):459-67 Abstract quote
Balanitis of Zoon is a relatively common diagnosis in elderly men,
although its nature is controversial and descriptions of its histopathologic
features in current textbooks of dermatopathology vary considerably.
We studied 45 cases of balanitis of Zoon clinically and histopathologically.
The earliest histopathologic changes in cases diagnosed clinically as
balanitis of Zoon were slight thickening of the epidermis, parakeratosis,
and a patchy lichenoid infiltrate of lymphocytes and some plasma cells.
More advanced cases showed atrophy of the epidermis, superficial erosions,
a scattering of neutrophils in the upper reaches of the epidermis, scant
spongiosis, extravasation of erythrocytes, and a much denser infiltrate
with many plasma cells.
Additional findings at even later stages were subepidermal clefts,
sometimes with loss of the entire epidermis, marked fibrosis of the
superficial dermis, and many siderophages. That sequence of histopathologic
changes is compatible with the thesis that balanitis of Zoon results
from irritation or mild trauma affecting barely keratinized skin in
a moist environment.
As a reaction to nonspecific stimuli, balanitis of Zoon may be found
superimposed on lesions of other diseases and may modify the histopathologic
presentation of those diseases to the extent that they are no longer
recognizable. In the current study, several cases diagnosed originally
as balanitis of Zoon turned out to be examples of allergic contact dermatitis,
psoriasis, lichen planus, and squamous cell carcinoma in situ.
It is important, therefore, to recognize balanitis of Zoon as a nonspecific
pattern that may occur either as an isolated finding or may complicate
other diseases affecting the glans penis or prepuce of uncircumcised
men. |
