43. Congenital malformations, inflammations and tumors of the penis

Congenital malformations of the penis?

3 are important:

- Diphallus

- Epispadias

- Hypospadias

Diphallus?

Presence of an accessory penis.

- Extremely rare

Epispadias?

Distal urethral orifice is present on the dorsal aspect of the penis

- Occurs when the genital tubercle fails to close

- Is associated with bladder exstrophy

Hypospadias?

Distal urethral orifice is present on the ventral/inferior aspect of the penis

- More common than epispadias

- Occurs when urethral folds fail to close

Inflammation of the penis?

- Balinitis/Balanoposthitis

- Phimosis/Paraphimosis

- Plasma cell balanitis

- Lichen sclerosus/penile Lichen sclerosus

- Peyronie disease

- Priapism

Balanitis/Balanoposthitis?

Balanitis: Inflammation of the glans

Balanoposthitis: Inflammation of the glans and prepuce

Often due to:

- Candida albicans

- Anaerobic bacteria

Phimosis/paraphimosis?

Phimosis: Tight foreskin that cannot be retracted completely

- Is physiological in young children

- Pathological in anyone older

Paraphimosis: Foreskin that has been retracted and cannot be returned to original position

- Often happens during medical procedures

- Improper blood supply to the glans penis -> cause it to swell and worsens the situation

- May become medical emergency to prevent gangrene

Reasons for phimosis to develop?

It can be congenital, but is in most cases acquired

Acquired form:

- Due to fibrosis of the prepuce as a complication of a balanitis/balanoposthitis

Plasma cell balanitis?

Uncommon condition that causes red patches on the penis

- Cause is unknown

- Condition may resemble precancerous lesion

Lichen sclerosus?

Chronic, progressive, inflammatory condition of the skin with characteristic white plaques

- Often affects the genital regions

Penile Lichen sclerosus:

- May cause scarring of the glans and prepuce

- Is a precancerous lesion & therefore increase risk of cancer

Peyronie disease (Penile fibromatosis)?

Type of fibromatosis -> fibrous growth

- Forms fibrous plaques on the penis

= Causes abnormal bending of the penis and painful erections

Priapism?

Any prolonged erection that occurs without or after stimulation has ceased

May occur due to:

- Sickle cell disease

- Trauma

- Embolization

- Drugs

- Neurological defects

What can priapism cause?

- Ischemia of the penis -> causing necrosis after 48h

= Should be treated as medical emergency

Tumor-like conditions of the penis?

- Condyloma acuminatum

- Trancho nodules/paraffin granuloma/paraffinomas

- Fournier gangrene

Condyloma acuminatum?

Genital warts - can occur on the penis

- Occurs after infection by HPV 6 or 11

- Characterized by koilocytic change

- Most frequently seen in sexually active young adults

How can Condyloma acuminatum lesions look like?

- Flat

- Papillary

- Warty

They regress spontaneously in 50% of patients

Tancho nodules/paraffin granulomas/paraffinomas?

Nodules that occur as a part of granulomatous inflammation

After injection of certain materials into the penis, like:

- Paraffin

- Vaseline

- Silicone

May be performed as a form of penile enlargement

May cause necrosis due to decreased circulation

Fournier gangrene?

Type of necrotizing fasciitis - occurs in the external genitalia or perineum

= Most commonly in scrotum

Life-threatening condition that can lead to sepsis

Why does fournier gangrene occur?

Occurs due to:

- Staphylococcal

- Streptococcal

infection

Predisposing factors of Fournier gangrene?

- DM (decrease wound healing)

- Alcoholism

- Immunosuppression

What is necrotizing fasciitis?

Bacterial infection of underlying fascia

- Flesh-eating bacteria

Four precancerous lesions (carcinoma in situ) of the penis?

- Penile lichen sclerosus

- Bowen disease

- Erythroplasia of Queyrat

- Bowenoid papulosis

Bowen disease?

Very early form of skin cancer, which is easily curable and characterized by a scaly patch lesions

Erythroplasia of Queyrat?

Appears as reddish plaques of the glans of the penis

Bowenoid papulosis?

Appears as reddish papules on the shaft

- Rarely progresses into invasice carcinoma

What cancer is most common in the penis?

Squamous cell carcinoma - accounts for 95% of cases of penile cancer

Who are most frequent to have penile cancer?

Older uncircumcised men with poor hygiene

Risk factors - squamous cell carcinoma of the penis?

- Poor hygiene (especially under the prepuce)

- HPV 16 and 18 infection

- Smoking

How can poor hygiene lead to cancer of the penis?

Poor hygiene of the glans -> retention of smegma -> causes balanitis

= Chronic balanitis predispose to squamous cell carcinoma

Morphology of penile carcinoma?

Begin as a grey, crusted and papular lesion

- Most commonly on the glans/prepuce

= Eventually tumor becomes ulcerated

Where can penile carcinoma spread?

- Spreads to inguinal lymph nodes by lymphatic dissemination

- Can spread to lungs by hematogenous dissemination

Tumor of the scrotum?

"Oscheoma"

- Most commonly squamous cell carcinoma

Has historical significance - as it was the first cancer to be associated with an environmental factor

= Chimney sweepers developed scrotal cancer more frequently, due to their exposure to soot