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Lesions and Neoplasms of the Penis: a Review

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Lesions and Neoplasms of the Penis: a Review Please do not remove this page Lesions and neoplasms of the penis: a review Heller, Debra https://scholarship.libraries.rutgers.edu/discovery/delivery/01RUT_INST:ResearchRepository/12643417590004646?l#13643521460004646 Heller, D. (2016). Lesions and neoplasms of the penis: a review. In Journal of Lower Genital Tract Disease (Vol. 20, Issue 1, pp. 107–111–). Rutgers University. https://doi.org/10.7282/T3P84DXN This work is protected by copyright. You are free to use this resource, with proper attribution, for research and educational purposes. Other uses, such as reproduction or publication, may require the permission of the copyright holder. Downloaded On 2021/09/23 09:01:32 -0400 Heller DS 1 Lesions and Neoplasms of the Penis-A Review 2 Debra S. Heller, MD 3 4 From the Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, 5 Newark, NJ 6 7 8 9 Address Correspondence to: 10 Debra S. Heller, MD 11 Dept of Pathology-UH/E158 12 Rutgers-New Jersey Medical School 13 185 South Orange Ave 14 Newark, NJ, 07103 15 Tel 973-972-0751 16 Fax 973-972-5724 17 [email protected] 18 Word count 2681 19 Running title: Lesions of the Penis 20 Disclosures: none 21 1 Heller DS 22 Precis: 23 Lesions and neoplasms of the penis are reviewed. 24 2 Heller DS 25 Abstract: 26 In addition to practitioners who care for male patients, with the increased use of high resolution 27 anoscopy, practitioners who care for women are seeing more men in their practices as well. 28 Some diseases affecting the penis can impact on their sexual partners. Many of the lesions and 29 neoplasms of the penis occur on the vulva as well. In addition, there are common and rare 30 lesions unique to the penis. A review of the scope of penile lesions and neoplasms that may 31 present in a primary care setting are presented to assist in developing a differential diagnosis if 32 such a patient is encountered, as well as for practitioners who care for their sexual partners. A 33 familiarity will assist with recognition, as well as when consultation is needed. 34 35 36 Key words: Penile neoplasms, penile diseases. 37 3 Heller DS 38 39 Introduction: 40 In addition to urologists and other practitioners who care predominantly for male patients, with 41 the increased use of high resolution anoscopy, practitioners who primarily care for women are 42 seeing more men as well. Some diseases affecting the penis can impact on their sexual partners. 43 A wide variety of conditions can affect the penis, both common, and case-report worthy. Many 44 are identical to lesions affecting the vulva, and there are unique lesions as well. This review is 45 provided to provide familiarity of some of the more commonly encountered as well as significant 46 lesions that may be seen in a primary care setting. This is aimed to assist in developing a 47 differential diagnosis if a patient with such a lesion is encountered, as well as for practitioners 48 who care for their sexual partners. A familiarity will assist with recognition, as well as when 49 consultation is needed. 50 Anatomy & Histology 51 The anatomy and histology of the penis are demonstrated in figure 1(fig 1)(1,2). 52 Pearly Penile Papules 53 These benign small papules are often found in a ring around the coronal sulcus, and are 54 often multiple(figure 2). They are a normal variant. Histologically they are composed of dense 55 connective tissue(3). 56 57 4 Heller DS 58 Fordyce Spots 59 Fordyce spots, prominent sebaceous glands, can be seen along the shaft of the penis(figure 3), 60 and are of no clinical significance. They tend to appear in adolescence(4). 61 62 Cysts of the penis 63 The majority of penile cysts are median raphe cysts, and occur ventrally along the median 64 raphe, anywhere from the urethra to the perineum. They are usually asymptomatic, and may 65 have a variety of linings, including columnar, squamous or mixed. Other less common cysts 66 include epidermal inclusion cysts(also called sebaceous cysts) and dermoid cysts(5). 67 68 Priapism 69 Priapism, a prolonged painful erection lasting generally over four hours can occur 70 spontaneously, or be associated with drugs utilized for erectile dysfunction. Other medications, 71 hematologic disorders, including sickle cell disease, neurologic disorders, and several other 72 uncommon medical conditions may also result in priapism. Most cases are ischemic, due to 73 venous engorgement of the corpora cavernosa, much like compartment syndrome, and requiring 74 emergent treatment. Subsequent erectile dysfunction may occur, even with treatment. The 75 mechanism of ischemic priapism may be intravascular, or due to muscular tissue inadequately 76 augmenting venous outflow. A less common non-emergent, often painless variant is due to 77 increased arterial flow from arteriovenous fistulas. While the treatment of priapism usually 5 Heller DS 78 requires a urologic specialist, terbutaline has been used as a first line therapy in the emergency 79 room(6). 80 81 82 Peyronie’s disease 83 Peyronie’s disease was first described in 1743 by François Gigot de La Peyronie , who 84 was a surgeon to Louis XV, and known for elevating surgery above the level of barber to the 85 level of physician(7). Peyronie’s disease is a chronic incurable condition of unknown etiology. 86 Chronic inflammation of the fibrous septa below the tunica albuginea leads to nodularity, with 87 curvature of the penis, with pain sometimes precluding intercourse. Etiology is unknown, but 88 there may be a hereditary component, as some patients also have Dupuytren’s contractures. 89 Clinically, the disease tends to go through an active phase, with painful erections, before entering 90 a quiescent phase with stabilization of the curvature deformity and resolution of the pain. 91 Erectile dysfunction may occur(8). Oral therapies have been used, including vitamin E, but none 92 has been shown to provide definite benefit(8). Therapy has included steroid injections and 93 surgery, but the condition is difficult to treat(3). More recent therapies have included injectables 94 such as verapamil, interferon and collagenase(8) as well as transdermal electromotive 95 administration of verapamil and dexamethasone(9). 96 97 6 Heller DS 98 Infectious & Inflammatory Lesions 99 A wide variety of dermatologic conditions that can occur elsewhere on the body may affect the 100 penis. Sexually transmitted diseases, including gonococcal or chlamydial urethritis, as well as 101 herpes, chancroid, or syphilis may also manifest on the penis(6). A few conditions specific to 102 the penis will be considered in the following section. 103 Molluscum Contagiosum 104 Molluscum is most often a pediatric disease, but it may affect the penis as it does the vulva, 105 and be sexually transmitted. As such, although lesions can regress, they have been treated with 106 cryotherapy(4) or scraping of the lesions to avoid spread. Grossly they appear as small papules 107 with umbilications. Histologically, these umbilications contain cells with characteristic 108 intracytoplasmic inclusions (figure 4). 109 110 Balanitis 111 Balanitis, inflammation of the glans, or balanoposthitis, which also includes the foreskin, may 112 be due to many causes, including bacteria, fungi, Trichomonas, a variety of dermatologic 113 conditions such as psoriasis, as a manifestation of a systemic disorder, or after exposure to an 114 irritant or trauma(3). Bacterial balanitis is usually a hygiene-related condition of the 115 uncircumcised, easily treated, although it may lead to phimosis. Rarely, in the 116 immunosuppressed, the infection may become life-threatening(3). 117 7 Heller DS 118 Candidal balanitis 119 Candidal balanitis deserves mention due to its possible association with candidal vaginitis in the 120 female partner, which must also be treated. The differential diagnosis is large, and candidal 121 balanitis must be distinguished from sexually transmitted diseases and other infections and 122 dermatoses of the glans. Diabetes increases the risk of candidal balanitis(10). There is no major 123 risk to a male for developing balanitis if his female partner has vulvovaginal candida(10). 124 Although there may be cases of sexual transmission of candida from men to women(11), 125 evidence does not support this as a significant risk(12). Rarely a male may develop a 126 hypersensitivity reaction rather than candidal infection to a female partner’s candida(3). 127 128 Plasma Cell Balanitis 129 Plasma cell(Zoon’s) balanitis, a condition of unknown etiology, is seen predominantly in 130 older uncircumcised men(3,13). It can occur on the vulva as well. Clinically it appears as a 131 well-circumscribed shiny bright orange-red lesion involving the inner prepuce or glans(13). 132 Histologically the lesion is composed of abundant plasma cells admixed with other chronic 133 inflammatory cells, hemosiderin, and prominent vessels, with changes in the overlying squamous 134 epithelium(13). Thought to be an inflammatory condition, circumcision has been used as 135 therapy(13), as have topical steroids(14). 136 137 8 Heller DS 138 Micaceous Balanitis 139 A rare condition of elderly uncircumcised or late circumcised men, pseudoepitheliomatous 140 keratotic and micaceous balanitis is postulated to be related to either verrucous carcinoma or 141 lichen sclerosus, and is considered a precursor lesion for squamous cell carcinoma. The lesion is 142 hyperkeratotic, and may be asymptomatic, but its periurethral location and thick plaques may 143 lead to multiple urinary streams, termed “watering can penis”(15). Grossly the lesion appears as 144 plaques or excrescences with scaling on the glans, which may ulcerate or crack. Histology is 145 nonspecific, with pseudoepitheliomatous hyperplasia, hyperkeratosis, parakeratosis, acanthosis 146 and nonspecific dermal lymphocytic and eosinophilic inflammation.
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