Penis and scrotum - Mondor’s phlebitis

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Penis and scrotum

Inflammatory lesions

Mondor’s phlebitis

Reviewers: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)

Revised: 20 February 2010, last major update February 2010

Definition

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● Uncommon and usually transient condition presenting as a cord-like lesion of the penis

Terminology

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● Also called superficial thrombophlebitis, Mondor’s disease or (incorrectly) non-venereal sclerosing lymphangitis

Epidemiology

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● Incidence of 1% of patients at STD clinic (Sex Transm Infect 2005;81:480)

● Most frequently affects young and middle-aged sexually active men

Sites

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● Preferentially affects the superficial dorsal penile vein

Etiology

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● Firm, subcutaneous cord-like structure(s) along dorsal shaft of penis or around coronal sulcus, due to massive thrombosis of superficial venous plexus of penis

● Causes: neoplasm, mechanical trauma during vigorous intercourse following sexual abstinence, sickle cell disease (J Am Osteopath Assoc 2003;103:102), long airline flight (Int J STD AIDS 2005;16:510), varicose vein surgery (J R Soc Med. 2001 Jun;94(6):292), herpes simplex infection

Clinical features

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● Firm, subcutaneous cord-like structures, mostly parallel to coronal sulcus

● Foreskin and dorsal midline of penile shaft can also be affected

● Pain and tenderness in a minority of cases, especially during erection

● Almost always self limited (spontaneous regression in 4-8 weeks), but associated with considerable psychological stress

Treatment

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● Temporary sexual abstinence

Clinical images

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Fig 1: Firm, cord-like lesion of coronal sulcus

Gross description (Macroscopy)

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● Firm, subcutaneous cord-like structures along dorsal shaft of penis or around coronal sulcus

Micro description (Histopathology)

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● Prominent vessels with plump endothelial cells and thickened (sclerotic) blood vessel walls (mainly veins), with occasional vessel showing complete occlusion of lumen

● Perivascular inflammatory infiltrate composed of lymphocytes, histiocytes and plasma cells

● No evidence of lymphatic involvement

Micro images

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Fig 2: Arteriole and venule with plump endothelial cells and thickened blood vessel wall along with perivascular

cellular infiltrate composed of lymphocytes, histiocytes, and plasma cells

Differential Diagnosis

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● Cutaneous polyarteritis nodosa: vasculitis involving small and medium sized arteries of the dermis and subcutaneous tissue

Additional references

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● eMedicine

End of Penis and scrotum > Inflammatory Lesions > Mondor’s phlebitis

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