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Penis (view source)

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The '''penis''' is occasionally afflicted by disease that the pathologist see.
The '''penis''' is occasionally afflicted by disease that the pathologist sees


It is afflicted by common [[dermatopathology|skin pathologies]].
It is afflicted by common [[dermatopathology|skin pathologies]].
=Normal=
*Corpus spongiosum - fills with blood during erection.<ref>{{Cite journal  | last1 = Zhang | first1 = XH. | last2 = Melman | first2 = A. | last3 = Disanto | first3 = ME. | title = Update on corpus cavernosum smooth muscle contractile pathways in erectile function: a role for testosterone? | journal = J Sex Med | volume = 8 | issue = 7 | pages = 1865-79 | month = Jul | year = 2011 | doi = 10.1111/j.1743-6109.2011.02218.x | PMID = 21324096 }}</ref>
*Corpus cavernosum - around the urethra.
===Image===
<gallery>
Image:Gray1155.png | Cross section of penis. (WC)
</gallery>


=Diseases=
=Diseases=
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*Balanoposthitis.
*Balanoposthitis.
*Balanatis.
*Balanatis.
**Plasma cell balanitis.
**[[Plasma cell balanitis]].
**[[Balanitis xerotica obliterans]].
**[[Balanitis xerotica obliterans]].
**Balanitis circinata.
**Balanitis circinata.
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*[[Idiopathic scrotal calcinosis]].
*[[Idiopathic scrotal calcinosis]].
*[[Melanocytic lesions]], esp. nevi.
*[[Melanocytic lesions]], esp. nevi.
*[[Fordyce spots]].


===Pre-cancerous===
===Pre-cancerous===
*Penile intraepithelial neoplasia (PIN).
*[[Penile intraepithelial neoplasia]] (PeIN).
*Paget disease (like [[extramammary Paget disease]]). (???)
*Paget disease (like [[extramammary Paget disease]]). (???)


===Neoplastic===
===Neoplastic===
*[[Squamous cell carcinoma]].
*[[Squamous cell carcinoma of the penis|Squamous cell carcinoma]].
*[[Merkel cell carcinoma]].
*[[Merkel cell carcinoma]].
*[[Sebaceous carcinoma]].
*[[Sebaceous carcinoma]].
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==Phimosis==
==Phimosis==
===General===
===General===
*Cannot be retract [[foreskin]].
*Cannot retract [[foreskin]].
*This is a clinical diagnosis.
*This is a clinical diagnosis.


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DDx - general:
DDx - general:
*[[Squamous cell carcinoma]].
*[[Squamous cell carcinoma]] - nuclear atypia + invasion.
*[[Balanitis xerotica obliterans]].
*[[Penile intraepithelial neoplasia]] - nuclear atypia.
*[[Lichen planus]].
*[[Lichen sclerosus]] - supeficial dermal fibrosis with thinned epidermis.
*Infection, e.g. [[syphilis]].
*[[Lichen planus]] - interface dermatitis with apoptotic bodies.
*Infection.
**[[Syphilis]] - plasma cells.
**[[Candidiasis]].
*[[Zoon balanitis]] - plasma cells.
 
===Sign out===
<pre>
FORESKIN, CIRCUMCISION:
- SKIN WITH PATCHY MILD NONSPECIFIC INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
FORESKIN, EXCISION:
- KERATINIZED SQUAMOUS EPITHELIUM WITH PATCHY MILD NON-SPECIFIC
  SUBEPITHELIAL INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
FORESKIN, CIRCUMCISION:
- BENIGN KERATINIZED SQUAMOUS EPITHELIUM.
- MILDLY FIBROUS SUBEPITHELIAL TISSUE WITH MINIMAL PATCHY NONSPECIFIC INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====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.
 
======Alternate======
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 focally thinned and focally flattened.
No significant hyperkeratosis or parakeratosis is apparent. The superficial
dermis shows no apparent fibrosis. No significant nuclear atypia is identified.


==Penile fibromatosis==
==Penile fibromatosis==
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==Zoon balanitis==
==Zoon balanitis==
*[[AKA]] ''balanitis circumscripta plasmacellularis''.<ref name=pmid20652106 >{{Cite journal  | last1 = Balato | first1 = N. | last2 = Scalvenzi | first2 = M. | last3 = La Bella | first3 = S. | last4 = Di Costanzo | first4 = L. | title = Zoon's Balanitis: Benign or Premalignant Lesion? | journal = Case Rep Dermatol | volume = 1 | issue = 1 | pages = 7-10 | month =  | year = 2009 | doi = 10.1159/000210440 | PMID = 20652106 }}</ref>
*[[AKA]] ''balanitis circumscripta plasmacellularis''.<ref name=pmid20652106 >{{Cite journal  | last1 = Balato | first1 = N. | last2 = Scalvenzi | first2 = M. | last3 = La Bella | first3 = S. | last4 = Di Costanzo | first4 = L. | title = Zoon's Balanitis: Benign or Premalignant Lesion? | journal = Case Rep Dermatol | volume = 1 | issue = 1 | pages = 7-10 | month =  | year = 2009 | doi = 10.1159/000210440 | PMID = 20652106 }}</ref>
*[[AKA]] ''plasma cell balanitis''.<ref name=pmid1992223>{{Cite journal  | last1 = Korenaga | first1 = D. | last2 = Kanematsu | first2 = T. | last3 = Watanabe | first3 = A. | last4 = Maehara | first4 = Y. | last5 = Kitano | first5 = S. | last6 = Sugimachi | first6 = K. | title = Clinical management of gastric cancer and concomitant esophagogastric varices. | journal = J Surg Oncol | volume = 46 | issue = 2 | pages = 91-6 | month = Feb | year = 1991 | doi =  | PMID = 1992223 }}</ref>


===General===
===General===
*Balanitis = inflammation of glands penis.
*Balanitis = inflammation of glands penis.
*Rare.
*Rare.
*Uncircumsized men.<ref name=pmid7884748>{{Cite journal  | last1 = Yoganathan | first1 = S. | last2 = Bohl | first2 = TG. | last3 = Mason | first3 = G. | title = Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases. | journal = J Reprod Med | volume = 39 | issue = 12 | pages = 939-44 | month = Dec | year = 1994 | doi =  | PMID = 7884748 }}</ref>
*Analogous to [[plasma cell vulvitis]] in women.
Treatment:<ref name=pmid7884748/>
*Circumcision.
*Corticosteroids.


===Microscopic===
===Microscopic===
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DDx:
DDx:
*[[Syphilis]].
*[[Syphilis]] - plasma cell-rich infiltrate.
*[[Balanitis xerotica obliterans]].
 
====Images====
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895202/figure/F2/ Zoon balanitis (nih.gov)].<ref name=pmid20652106/>
<gallery>
Image: Penis Zoons Balanitis MP 4 PA.jpg|Note the flattened 'lozenge' keratinocytes separated by spongiosis (SKB).
Image: Penis Zoons Balanitis MP 3 PA.jpg|The epidermis is very atrophic in this example but shows 'lozenge' keratinocytes and spongiosis (SKB).
Image: Penis Zoon Balanitis SNP.jpg||This example might at first glance appear to be a lichenoid balanitis but the thin layer of epidermis is actually intact (SKB).
</gallery>
 
===Sign out===
<pre>
PENILE FORESKIN, CIRCUMCISION:
- COMPATIBLE WITH PLASMA CELL BALANITIS (ZOON BALANITIS), SEE COMMENT.
 
COMMENT:
A treponemal infection should be considered clinically.
</pre>
 
==Squamous cell carcinoma of the penis==
{{Main|Squamous cell carcinoma of the penis}}


=See also=
=See also=
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=References=
=References=
{{Reflist|1}}
{{Reflist|1}}
=External links=
*[http://www.hawaii.edu/hivandaids/Common%20Penile%20Lesions%20%20%20Tips%20To%20The%20Differential.pdf DDx of penile lesions (hawaii.edu)].
*[http://www.netdoctor.co.uk/menshealth/facts/spotsonthepenis.htm Spots on the penis (netdoctor.co.uk)].


[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
Michael
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