Penis
The penis is occasionally afflicted by disease that the pathologist see.
It is afflicted by common skin pathologies.
Normal
- Corpus spongiosum - fills with blood during erection.[1]
- Corpus cavernosum - around the urethra.
Image
Cross section of penis. (WC)
Diseases
Inflammatory
- Phimosis.
- Paraphimosis.
- Balanoposthitis.
- Balanatis.
- Plasma cell balanitis.
- Balanitis xerotica obliterans.
- Balanitis circinata.
- Lipogranulomas.
Infectious
- HPV infection.
- HSV infection.
- Scabies.
- Pediculosis pubis.
- Syphilis.
- Gonorrhea.
- Lymphogranuloma venereum.
- Granuloma inguinale.
- Chancroid.
- Molluscum contagiosum.
- Filariasis - elephantiasis.
Other non-tumour
- Idiopathic scrotal calcinosis.
- Melanocytic lesions, esp. nevi.
- Fordyce spots.
Pre-cancerous
- Penile intraepithelial neoplasia (PIN).
- Paget disease (like extramammary Paget disease). (???)
Neoplastic
- Squamous cell carcinoma.
- Merkel cell carcinoma.
- Sebaceous carcinoma.
- Clear cell carcinoma.
- Basal cell carcinoma.
- Melanoma.
Others:
- Mesenchymal lesions - see: soft tissue lesions.
- Hematopoetic, e.g. lymphoma.
- Metastasis.
Specific conditions
Phimosis
General
- Cannot retract foreskin.
- This is a clinical diagnosis.
Microscopic
Features:[2]
- +/-Inflammation.
- Fibrosis.
Notes: Findings non-specific.
DDx - general:
- Squamous cell carcinoma - nuclear atypia.
- Lichen sclerosus - supeficial dermal fibrosis with thinned epidermis.
- Lichen planus - interface dermatitis with apoptotic bodies.
- Infection.
- Syphilis - plasma cells.
- Candidiasis.
- Zoon balanitis - plasma cells.
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FORESKIN, CIRCUMCISION: - SKIN WITH PATCHY MILD NONSPECIFIC INFLAMMATION. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
FORESKIN, EXCISION: - KERATINIZED SQUAMOUS EPITHELIUM WITH PATCHY MILD NON-SPECIFIC SUBEPITHELIAL INFLAMMATION. - NEGATIVE FOR MALIGNANCY.
FORESKIN, CIRCUMCISION: - BENIGN KERATINIZED SQUAMOUS EPITHELIUM. - MILDLY FIBROUS SUBEPITHELIAL TISSUE WITH MINIMAL PATCHY NONSPECIFIC INFLAMMATION. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Micro
The sections show skin with mild patchy chronic inflammation, consisting predominantly of lymphocytes, at the dermal-epidermal junction. The epidermis matures to the surface, has rete ridges and is of a normal thickness. Focally, parakeratosis is present. No significant nuclear atypia is identified.
Thinned epidermis
The sections show skin with mild patchy chronic inflammation, consisting predominantly of lymphocytes, at the dermal-epidermal junction. Eosinophils are not readily apparent.
The epidermis matures to the surface; however, it is thinned and focally flattened appearing. No hyperkeratosis or parakeratosis is apparent. The superficial dermis is minimally hyalinized focally. No significant nuclear atypia is identified.
Penile fibromatosis
- AKA Peyronie's disease.
General
- Prevalence ~5%.[3]
Treatment:
- Conservative versus surgery.
Gross
- Abnormal curvature of the penis, esp. in the erect state.
Microscopic
Features:[3]
- Tunica albuginea fibrosis.
Zoon balanitis
General
- Balanitis = inflammation of glands penis.
- Rare.
- Uncircumsized men.[6]
- Analogous to plasma cell vulvitis in women.
Treatment:[6]
- Circumcision.
- Corticosteroids.
Microscopic
Features:[4]
- Abundant plasma cells - key feature.
- Dermal atrophy.
- Spongiosis and intraepithelial lymphocytes.
- Tortuosity dermal blood vessels.
DDx:
- Syphilis - plasma cell-rich infiltrate.
- Balanitis xerotica obliterans.
Images
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PENILE FORESKIN, CIRCUMCISION: - COMPATIBLE WITH PLASMA CELL BALANITIS (ZOON BALANITIS), SEE COMMENT. COMMENT: A treponemal infection should be considered clinically.
Squamous cell carcinoma of the penis
See also
References
- ↑ Zhang, XH.; Melman, A.; Disanto, ME. (Jul 2011). "Update on corpus cavernosum smooth muscle contractile pathways in erectile function: a role for testosterone?". J Sex Med 8 (7): 1865-79. doi:10.1111/j.1743-6109.2011.02218.x. PMID 21324096.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 391. ISBN 978-0781765275.
- ↑ 3.0 3.1 Serefoglu, EC.; Hellstrom, WJ. (Dec 2011). "Treatment of Peyronie's disease: 2012 update.". Curr Urol Rep 12 (6): 444-52. doi:10.1007/s11934-011-0212-2. PMID 21818660.
- ↑ 4.0 4.1 4.2 Balato, N.; Scalvenzi, M.; La Bella, S.; Di Costanzo, L. (2009). "Zoon's Balanitis: Benign or Premalignant Lesion?". Case Rep Dermatol 1 (1): 7-10. doi:10.1159/000210440. PMID 20652106.
- ↑ Korenaga, D.; Kanematsu, T.; Watanabe, A.; Maehara, Y.; Kitano, S.; Sugimachi, K. (Feb 1991). "Clinical management of gastric cancer and concomitant esophagogastric varices.". J Surg Oncol 46 (2): 91-6. PMID 1992223.
- ↑ 6.0 6.1 Yoganathan, S.; Bohl, TG.; Mason, G. (Dec 1994). "Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases.". J Reprod Med 39 (12): 939-44. PMID 7884748.