Difference between revisions of "Penis"

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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.
Line 30: Line 39:
*[[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]].
Line 51: Line 61:
==Phimosis==
==Phimosis==
===General===
===General===
*Cannot be retract forskin.
*Cannot retract [[foreskin]].
*Clinical diagnosis.
*This is a clinical diagnosis.


===Microscopic===
===Microscopic===
Line 60: Line 70:


Notes: Findings non-specific.
Notes: Findings non-specific.
DDx - general:
*[[Squamous cell carcinoma]] - nuclear atypia + invasion.
*[[Penile intraepithelial neoplasia]] - 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.
===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==
{{Main|Fibromatosis}}
*[[AKA]] ''Peyronie's disease''.
===General===
*Prevalence ~5%.<ref name=pmid21818660/>
Treatment:
*Conservative versus surgery.
===Gross===
*Abnormal curvature of the penis, esp. in the erect state.
===Microscopic===
Features:<ref name=pmid21818660>{{Cite journal  | last1 = Serefoglu | first1 = EC. | last2 = Hellstrom | first2 = WJ. | title = Treatment of Peyronie's disease: 2012 update. | journal = Curr Urol Rep | volume = 12 | issue = 6 | pages = 444-52 | month = Dec | year = 2011 | doi = 10.1007/s11934-011-0212-2 | PMID = 21818660 }}</ref>
*Tunica albuginea fibrosis.
==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]] ''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===
*Balanitis = inflammation of glands penis.
*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===
Features:<ref name=pmid20652106/>
*Abundant [[plasma cell]]s - '''key feature'''.
*Dermal atrophy.
*[[Spongiosis]] and intraepithelial lymphocytes.
*Tortuosity dermal [[blood vessel]]s.
DDx:
*[[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=
Line 68: Line 188:
=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]]

Latest revision as of 04:14, 22 July 2015

The penis is occasionally afflicted by disease that the pathologist sees

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

Infectious

Other non-tumour

Pre-cancerous

Neoplastic

Others:

Specific conditions

Phimosis

General

  • Cannot retract foreskin.
  • This is a clinical diagnosis.

Microscopic

Features:[2]

  • +/-Inflammation.
  • Fibrosis.

Notes: Findings non-specific.

DDx - general:

Sign out

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.

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

Main article: 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

  • AKA balanitis circumscripta plasmacellularis.[4]
  • AKA plasma cell balanitis.[5]

General

Treatment:[6]

  • Circumcision.
  • Corticosteroids.

Microscopic

Features:[4]

DDx:

Images

  • Note the flattened 'lozenge' keratinocytes separated by spongiosis (SKB).

  • The epidermis is very atrophic in this example but shows 'lozenge' keratinocytes and spongiosis (SKB).

  • This example might at first glance appear to be a lichenoid balanitis but the thin layer of epidermis is actually intact (SKB).

Sign out

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

Main article: Squamous cell carcinoma of the penis

See also

References

  1. ↑ 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.
  2. ↑ 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. ↑ 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. ↑ 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.
  5. ↑ 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. ↑ 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.

External links

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