Penile Involvement Research Articles

Penile and Scrotal Porokeratosis: A Single-Institution Experience.

There is a paucity of data regarding porokeratosis confined to the penis and scrotum. We evaluated our single-institutional experience regarding this entity. We interrogated our pathology archive for all specimens from the penis or scrotum, signed out as porokeratosis between 2000 and 2022. Clinical and histopathological features were reviewed, including the number of cornoid lamella(e) per tissue profile and squamous dysplasia. Nine patients were included in the study. The median age at the time of diagnosis was 51 years. Multiple lesions were present in 3 patients. Six patients had exclusively penile involvement, whereas 2 patients had exclusively scrotal involvement. One patient had multiple lesions consistent with porokeratosis ptychotropica, extending from the scrotum to the buttocks and perineum. Clinically, a collarette of scale was noted in 3 patients and diagnosis of porokeratosis was considered in 1 patient before biopsy. Histopathologically, 2 patients exhibited multiple cornoid lamellae in the same profile and 1 patient had follicular cornoid lamellae. Focal squamous dysplasia was only present in 1 patient. Follow-up was available for 5 patients (median duration: 35 months). In 4 patients, the lesions were removed completely during the shave biopsy procedure. At the past follow-up, there were no signs of recurrence or malignant transformation to squamous cell carcinoma in any patient. Porokeratosis involving the penis and/or scrotum may be elusive to diagnosis based on clinical features alone, emphasizing the role of histopathological examination. Increased awareness of this entity may help better delineate its clinicopathological presentation and appropriate classification.

Tuberculosis of Penile ShaftA Rare Clinical Presentation

Tuberculosis (TB) is an opportunistic infection caused by Mycobacterium TB, and it has plagued mankind since ages, posing a major health concern in developing countries. Pulmonary TB is the most common form, but extrapulmonary TB is also not uncommon, with an incidence of 8-14%. Cutaneous manifestations of TB, known as lupus vulgaris, are extremely rare, constituting less than 1% of cases worldwide. Diagnosing a cutaneous lesion of TB poses a challenge for clinicians, as it requires both absolute and relative criteria. In the present case report, the author presents the case of a 15-year-old male from a low socio-economic background who presented with painless oedema over the penis for one and a half months. The patient had a history of dry cough and tested positive for Coronavirus Disease-2019 (COVID-19). Systemic examination was normal, and vital signs were stable. Local examination revealed oedema, redness, and phimosis over the penile shaft, along with non tender ulcerative lesions and deep cracks in the groin crease. A skin biopsy revealed lymphocytic infiltration with Langhanstype giant cells and epithelioid cell granulomas, suggesting TB of the skin overlying the penis. Laboratory investigations revealed a positive Mantoux test and an elevated Erythrocyte Sedimentation Rate (ESR) of 42. The patient was initiated on antitubercular therapy, comprising isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). After one month of treatment, the oedema subsided, and the penile ulcers and groin skin cracks healed. Penile skin involvement in TB is rare, and the clinical appearance of such involvement may vary.

Association of severe Raynaud’s phenomenon with psoriasis – a rare manifestation

Raynaud’s phenomenon defines the clinical consequence of recurrent vasospasm of the small arteries, arterioles, and arteriovenous shunts of the fingers and toes provoked by cold and emotional stress. Other acral parts, such as the nose, lips, ears, and penis, may also be affected. Despite several similarities between the pathogenesis of psoriasis and autoimmune diseases, it was surprising to find low frequencies of disease associations. We present a case of a 19-year-old boy with familial chronic plaque psoriasis who developed severe Raynaud’s syndrome with penile involvement.

SAT246 Ectopic (Penile) Calcification in 1, 25 Vitamin D Induced Hypercalcemia

Abstract Disclosure: J. Berquist: None. D.S. Reddy: None. A 60-year-old male with a history of well controlled type 2 diabetes and HTN presented with acute renal failure (initial creatinine 19.9 mg/dL, GFR 11). Kidney biopsy during admission was consistent with acute tubular necrosis and mild diabetic nephropathy. Serum calcium was normal at that time. He received temporary dialysis and eventually discharged home with improved (though still elevated) creatinine. On follow up labs a month later, he was noted to have high serum calcium. He was temporarily lost to follow up and was readmitted four months later due to persistent severe hypercalcemia. Peak serum calcium on his new admission was 13.2 mg/dL. Phosphorus level three months prior was 5.9 mg/dL, though had now improved to 2.7 mg/dL. Other labs this admission include creatinine 2.54 and GFR 33 (which was consistent with previous months), PTH 11 pg/mL, 25-OH Vitamin D 10 ng/mL, 1,25-Dihydroxy Vitamin D elevated at 84.8 pg/mL and magnesium low at 1.5 mg/dL. SPEP and UPEP were both negative and PTHrP was not measured. Kappa/Lamda free light chain ratio was mildly elevated at 1.77 (0.26-1.65). QuantiFERON Gold, HIV, Beta-2 microglobulin, ANA, and flow cytometry were negative. He received calcitonin x 2, IVF, zoledronic acid, and denosumab (three days later), which improved his calcium to 11.5 by discharge 11 days later. He underwent a CT Chest/Abdomen/Pelvis, T spine, and L spine that were remarkable for multiple bilateral partially calcified pulmonary nodules and hepatic steatosis with splenomegaly. PET CT showed 20 hypermetabolic osseous lesions throughout axial skeleton, multiple pulmonary, liver, and splenic lesions and lymphadenopathy in the head, neck, chest, abdomen. There was also diffuse calcification of the penile corpora. Pathology via biopsies of a retroperitoneal lymph node as well as bone marrow showed non-caseating granulomas. Lastly, 1-2 months ago, he noticed pain and hardening of his penis. On exam, there is a deep firmness with palpation and distal penile tenderness. There are no cutaneous lesions on the penis or anywhere else on the skin. Calciphylaxis was a consideration, but isolated penile involvement is rare. Additionally, it is rare to develop calciphylaxis without end stage renal disease. A review of the literature showed many cases of penile calciphylaxis, though none were without cutaneous involvement. Sarcoidosis of the penis is also very rare and cases in the literature cite either a cutaneous or intraurethral lesion. This case appears unique in the findings of penile calcification palpable on exam and visible on imaging, without any cutaneous manifestations, in the setting of previous though recovered acute renal failure and 1, 25 Vitamin D-mediated hypercalcemia in sarcoidosis. Presentation: Saturday, June 17, 2023

Fournier’s gangrene reconstruction: A 10-year retrospective analysis of practice at Guys and St Thomas’s NHS Foundation Trust

Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management. Between January 2010 and January 2020, all perineal debridement operation notes were examined. The primary conclusions were that a large majority of defects could be repaired using split skin grafts to reduce surgical time and donor site morbidity. To avoid secondary contracture and the need for revision surgery, full-thickness skin grafts should be used whenever possible to treat penile defects.

Unusual presentation of classical Kaposi Sarcoma: penile involvement in an HIV sero-negative patient

Background: Kaposi's sarcoma (KS) is a multifocal, angioproliferative malignant lesion originating from lymphatic endothelial cells. KS limited to the penis is extremely rare in human immunodeficiency virus (HIV) sero-negative patients. In this study, we aimed to present a case of isolated primary penile KS unrelated to HIV. Case Presentation: A 65-year-old man, with no risk factors for KS, presented with reddish nodules on penis. Biopsy was recommended to the patient for definitive diagnosis. Histopathological examination revealed that the diagnosis was classical type KS. No distant metastases were detected. No recurrence or disease progression was detected during the 4-year follow-up. Conclusion: Isolated primary penile KS is extremely rare in HIV sero-negative patients, but it should be kept in mind in the differential diagnosis of pigmented and nodular lesions in the penis. Excision of lesions with negative surgical margins has a high success and very low complication rate, as in our case.

Systemic Immunoglobulin Light Chain Amyloidosis Presenting as Painful Penile Ulcers

Immunoglobulin light chain (AL) amyloidosis is a systemic form of amyloidosis that commonly affects the heart, kidney, liver, and nervous system. Penile involvement in AL amyloidosis is rare and thus often not considered in the differential diagnosis for penile ulcers. We report a case of an elderly man with nonhealing, painful penile ulcers who had AL amyloidosis with cardiac, renal, and liver involvement. His penile lesions were successfully treated with surgical resection of the amyloid deposits. Even after serologic relapse of his systemic amyloidosis, he has not had recurrence of his penile ulcers many years later.

An Unusual FDG-PET/CT Documentation in Aleukemic Leukemia Cutis: Atypical Penile, Scrotal, and Leg Muscles Involvement.

Aleukemic leukemia cutis (ALC) is a rare condition with a relatively poor prognosis, clinically presenting as skin and subcutaneous nodules commonly involving head and neck region with discrete atypical leukemic cells infiltrating in the skin on histopathology. The lesions on the genital area skin are seldom reported. A 49-year-old male presented with joint pains and multiple subcutaneous nodules clinically with biopsy proving it as leukemia cutis. Bone marrow aspiration and biopsy were suggestive of normocellular myeloid preponderant bone marrow with mild increase in eosinophils. The 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) revealed metabolically active FDG avid ill-defined soft tissue attenuation involving the entire length of penile shaft with central necrotic area, diffuse scrota skin thickening, and lateral compartment muscles of left leg, in addition to multiple hypermetabolic metastatic lymph nodes, and diffuse hypermetabolic marrow in humerii and femora. Despite prompt investigations and initiation of management, the patient succumbed in 15 days post-FDG PET/CT. The present report depicts an atypical case of ALC, with FDG PET-CT showing extensive and unusual sites of disease involvement, emphasizing its potential role in ALC.

External Male Genitalia in Henoch-Schönlein Syndrome: A Systematic Review.

The external genitalia are notoriously implicated in every fifth male with Henoch–Schönlein syndrome. Nonetheless, the underlying conditions are poorly categorized. To characterize the involvement of the external male genitalia in this vasculitis, we performed a systematic review of the literature. For the final analysis, we selected 85 reports published between 1972 and 2022, which reported on 114 Henoch–Schönlein cases (≤ 18 years, N = 104) with a penile (N = 18), a scrotal (N = 77), or both a penile and a scrotal (N = 19) involvement. The genital involvement mostly appeared concurrently with or after the cutaneous features of Henoch–Schönlein syndrome, while it preceded the presentation of Henoch–Schönlein syndrome in 10 cases. Patients with penile involvement (N = 37) presented with swelling (N = 26), erythema (N = 23), and purpuric rash (N = 15). Most patients were otherwise asymptomatic except for transient micturition disorders (N = 2) or priapism (N = 2). Patients with scrotal involvement (N = 96) presented with pain (N = 85), swelling (N = 79), erythema (N = 42), or scrotal purpura (N = 22). The following scrotal structures were often involved: scrotal skin (N = 83), epididymis (N = 49), and testes (N = 39). An ischemic testicular damage was noted in nine patients (four with torsion and five without). The scrotal skin involvement was mostly bilateral, while that of the epididymis and testis were mostly (p < 0.0001) unilateral (with a significant predilection for the left side). In conclusion, this analysis allows for better categorization of the involvement of external male genitalia in Henoch–Schönlein vasculitis. Scrotal involvement can result from skin inflammation, epididymitis, orchitis, or testicular ischemia.

SARS-CoV-2 and Clinical Urology: There is no Dragon in this Story

Covid-19 disease is caused by the coronavirus of severe acute respiratory syndrome 2. The disease has evolved into a global pandemic that continues to this day. Coronavirus basically causes acute respiratory illness, the symptoms of which may remain milder even three months after the onset of this acute infection. Many patients also experience cardiological, gastrointestinal, and neurological symptoms that last for at least two months. Some patients report worsening of certain urinary symptoms. In this paper, we review the current knowledge about the relationship between SARS-CoV-2 and urinary system. A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, PubMed, Embase, the Cochrane Library, and other libraries using the keywords “SARS-CoV-2,” “COVID-19,” and “pandemic,” in various combinations with the terms “kidney,” “bladder” “prostate,” “testicles,” “LUTS,” “pain,” and “infection.” A considerable number of articles investigate the possible interaction between SARS-CoV-2 and the urinary system. In addition, to the well-documented involvement of the kidneys, testicle, and penile involvement seems to be possible. There are also studies investigating the development of benign prostatic hypertrophy (BPH) as a complication of SARS-CoV-2 infection and some studies examining the impact of COVID-19 disease on LUTS. In conclusion, the studies published so far do not provide conclusive evidence about a strong association between SARS-CoV-2 and the genitourinary system. Further investigation is warranted to better understand the nature of COVID-19 disease.

Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report

BackgroundKaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable.Case presentationA 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment.ConclusionThis case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.

Extranodal natural-killer/T-cell lymphoma, nasal type: An immunomorphological study from a regional cancer institute in India.

Extranodal natural-killer/T-cell lymphoma, nasal type (ENKTL), is a rare, aggressive, predominantly extranodal non-Hodgkin lymphoma (NHL) of putative natural-killer (NK) cell and rarely T-cell origin, always associated with Epstein-Barr virus (EBV) infection and characterized by highly distinctive histopathological features with predilection for the upper aerodigestive tract. While the nasal cavity is the prototypical site, less frequently extranasal ENKTL can also occur. The objective of this case series is to study the immunomorphological features of ENKTL from a tertiary cancer centre as the data are sparse from India despite it being a distinct entity with characteristic clinicopathological features. We identified 11 cases of ENKTL from the departmental archives between January 2015 and June 2018. The clinicopathological and immunohistochemistry (IHC) findings of these tumors were analyzed. EBV encoded RNA (EBER) in situ hybridization (EBER-ISH) for EBV was done in eight cases. The disease was more common in males (male: female ratio 1.8:1) with the mean age of 45 years (range 31-65 years). Sinonasal region was the most common site with 9 cases and skin and penis were involved in one case each. The patient with penile involvement on further investigations was found to have occult nasal involvement, Histomorphological features such as angiocentricity/angioinvasion was seen in seven cases (63.6%) and significant necrosis was present in all 11 cases (100%). All cases were uniformly positive for cytoplasmic CD3 and CD56 with high Ki67 proliferating index and EBER-ISH test for EBV was positive in all the eight cases. ENKTL is an aggressive NHL and should be differentiated from other T- and B-cell lymphomas as the prognosis and therapy differ. Nasal biopsies showing predominant necrosis and atypical lymphoid cells with angiocentricity must raise the suspicion of ENKTL and should be confirmed by immunomorphological and molecular studies.

Penile involvement of immunoglobulin a vasculitis/Henoch-Schönlein purpura

Immunoglobulin A vasculitis/Henoch-Schönlein purpura (IgAV/HSP) is a leukocytoclasia vasculitis of childhood, predominantly affecting the skin, joints, gastrointestinal tract, and kidneys. The involvement of the penis is rare. We aimed to describe this rare manifestation of IgAV/HSP and to review the previous studies, including similar cases. Clinical data were reviewed for two children of penile involvement of IgAV/HSP in our hospital. More clinical cases were retrieved from the databases of PubMed/MEDLINE and Scopus from database inception to February 1, 2020. We presented two boys aged three and five years both of whom had penile lesions after presenting with the typical rash of IgAV/HSP on lower extremities. The penile lesions improved entirely in a few days without treatment in one and with corticosteroid treatment in the other. The literature review revealed 12 articles describing 20 patients with penile involvement of IgAV/HSP. The penile findings were edema, erythema, ecchymosis, purpuric rash, edema, color change, stiffness of the shaft or prepuce, and tenderness. Penile lesions appeared before the purpuric rash of IgAV/HSP in three of 22 patients. The penile involvement could make the diagnosis challenging especially if the penile lesions appear before the typical rash of the disease. The lesions improved entirely in the short term in all patients; in five without treatment in fifteen after corticosteroid or immunosuppressive drug treatment. It is important to raise awareness about this rare manifestation among health care providers. It is not clear whether corticosteroid treatment should be initiated for treatment since it seems as a self-limited feature. Treatment with corticosteroids could be considered in the treatment of selected cases especially with systemic involvement.

Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration

Report _Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration Authors: Marie Danset, Cécile Lesort, Denis Jullien, Jean Kanitakis Affiliations: Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France Corresponding Author: Jean Kanitakis, Department of Dermatology, Edouard Herriot Hospital Group, 69437 Lyon Cedex 03, France, Tel: 33-472110301, Email: jean.kanitakis@univ-lyon1.fr Abstract: Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis.

Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration

Report _Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration Authors: Marie Danset, Cécile Lesort, Denis Jullien, Jean Kanitakis Affiliations: Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France Corresponding Author: Jean Kanitakis, Department of Dermatology, Edouard Herriot Hospital Group, 69437 Lyon Cedex 03, France, Tel: 33-472110301, Email: jean.kanitakis@univ-lyon1.fr Abstract: Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis.

441 Penile calciphylaxis: A retrospective analysis of ten cases

Background: Calciphylaxis is a disorder of vascular calcium deposition leading to ischemia and skin necrosis. Rarely, there may be penile involvement, which has not been well documented. Here we describe ten cases of penile calciphylaxis to assess risk factors and mortality. Methods: A case series of patients with penile calciphylaxis at Massachusetts General Hospital and Beth Israel Deaconess Medical Center was generated through retrospective chart review of patients with a diagnosis of calciphylaxis between January 2001 to December 2018.

Penile calciphylaxis: A retrospective case-control study

Calciphylaxis is a rare disorder characterized by skin necrosis caused by calcium deposition within vessels, thrombosis, and subsequent tissue ischemia. Penile involvement may rarely occur. To identify risk factors, diagnosis, management, and mortality of patients with penile calciphylaxis. A retrospective medical record review was conducted of 16 patients with penile calciphylaxis treated at 2 large urban tertiary care centers between January 2001 and December 2019. A control group of 44 male patients with nonpenile calciphylaxis at the same institution was included. The median survival of patients with penile calciphylaxis was 3.8months (interquartile range, 27.0months). Mortality was 50% at 3months and 62.5% at 6months for penile calciphylaxis, and 13.6% at 3months and 29.5% at 6months for controls (P=.008). Patients with penile calciphylaxis were less likely to be obese (P=.04) but more likely to have hyperparathyroidism (P=.0003) and end-stage renal disease (P=.049). Retrospective study design and small sample size. This study further defines the disease course of penile calciphylaxis, which has high mortality. Imaging may be used to aid diagnosis. Risk factors include end-stage renal disease, hyperparathyroidism, and normal body mass index.

Penile Calciphylaxis

The proposed image reports the case of penile calciphylaxis. Calciphylaxis is a rare obliterative small vessel vasculopathy associated with diabetes mellitus, end-stage renal disease. Penile involvement is even rarer with only 50 cases reported, and agreement on appropriate diagnosis and management is unclear. This rarity exposes, as in our situation, to misdiagnosis, with possible iatrogeny (dermocorticoides in the case of balanitis). As the biopsy of the glans is not recommended, the clinical diagnosis is essential. Diffuse calcifications appearance on the reported ultrasound could support the diagnosis.

34. An unusual presentation of a cervical mass

34. An unusual presentation of a cervical mass

Acute Infantile Hemorrhagic Edema with Penile Involvement

Acute Infantile Hemorrhagic Edema with Penile Involvement