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28 January 2014 - Case of the Week #340

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Thanks to Dr. Koteeswaran Govindaswamy, Mahatma Gandhi Medical College and Research Institute (India), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.

Five Day Course
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A Practical Approach to Common Problems in Surgical Pathology:
Focus on GI, Soft Tissue and GU Pathology


John R. Goldblum, M.D., Course Director, The Cleveland Clinic
Kristin Atkins, M.D., University of Virginia Medical Center
Joel K. Greenson, M.D., University of Michigan
Jeffrey Myers, M.D., University of Michigan
Ed Stelow, M.D., Medical College of Wisconsin



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Case of the Week #340

Clinical History:
A nodular fleshy mass on the glans penis had an ulcerated surface, and was clinically suspicious for squamous cell carcinoma. It measured 4.0 x 3.5 cm, and was excised.

Gross images:

Micro images:

Additional images:

What is your diagnosis?

Granuloma pyogenicum

Granuloma pyogenicum are common, acquired vascular lesions occuring in the fingers, feet, head and oral mucosa. It is rarely reported in the penis, typically in the glans, with single and multiple lesions up to 1 cm (Genitourin Med 1995;71:43, Sex Transm Infect 1998;74:221). In this case, the large size presented a clinical differential diagnosis of giant condyloma, sarcomatoid carcinoma, nodular melanoma and malignant fibrous histiocytoma (Anal Quant Cytol Histol 2006;28:193).

Histologically, the surface areas showed extensive ulceration with fibrin, neutrophils and debris, with focal preservation of the surface stratified squamous epithelium and superficial benign proliferation. Other sections showed a marked proliferation of capillaries with surrounding edematous or myxoid stroma infiltrated with lymphocytes.

The pathogenesis is probably related to trauma. Excision is adequate treatment for this benign lesion.

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