Penis and scrotum - Peyronie’s disease

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Penis and scrotum

Inflammatory lesions

Peyronie’s disease

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

Revised: 21 February 2010, last major update February 2010

Definition

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● Dense focal fibrosis of dermis and Buck’s fascia of penile shaft between corpora cavernosa and tunica albuginea, usually causing curvature towards side of lesion and restricting movement of these structures during erection

Terminology

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● Also called “induratio penis plastica”

Epidemiology

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● Typically whites age 40+ years, rarely age 40 or less (J Androl 2003;24:27)

● Prevalence 0.3-4% (Int J Impot Res 2002;14:379)

Etiology

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● Considered a variant of superficial fibromatosis which preferentially affects the tunica albuginea

● May be related to microtrauma (coital, urethral instrumentation), which releases fibroblast related cytokines

● May arise secondary to urethritis as a sclerosing inflammatory process

Clinical features

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● May be associated with carcinoid syndrome, Dupuytren’s contracture

● May be associated with beta blockers, thiazides (J Sex Med 2009 Nov 12 [Epub ahead of print]), hypertension, diabetes and immune reactions

● Fibrosis produces an abnormal curvature of the penis, which may cause pain during erection and intercourse

● In some cases, nodules adherent to tunica albuginea are noted over the mid dorsal line

● May be clinically mimicked by epithelioid sarcoma (Int J Impot Res 2003;15:378)

Case reports

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● 59 year old man with Peyronie’s disease and ossification (Sao Paulo Med J 2007;125:124)

Treatment

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● Often surgical (Adv Urol 2008:263450)

● Responds to laser therapy and small amounts of irradiation and injected steroids (J Androl 2009 Aug 14 [Epub ahead of print]) and interferon

● Prosthesis may be useful (Adv Urol. 2008:646052)

● Some non-surgical options may stabilize disease (Asian J Androl 2008;10:79)

● May spontaneously regress

Clinical images

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AFIP Fig 10-81

Urologic surgical pathology 1997

Gross description (Macroscopy)

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● Irregular areas of fibrosis in dermis and fascia of penile shaft, mainly related to and in contact with tunica albuginea

● Occasionally nodular areas of fibrosis may predominate

Gross images

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AFIP Fig 10-82: Tunica albuginea surrounding both corpora cavernosa is thickened

Micro description (Histopathology)

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● Dense fibrous nodules, similar to those in Dupuytren’s contracture, fibromatosis and other desmoplastic conditions involving myofibroblasts

● More dense and less cellular than other types of superficial fibromatosis

● Perivascular lymphoid infiltrate in early stages of disease

● Fibrotic tunica albuginea with extension of fibrosis to corpus cavernosum

● Abnormal vessels with venous leakages

● Calcification or ossification may occur

Micro images

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AFIP images

Fig 10-81 Fig 10-82: Whole mount shows focal thickening

of tunica albuginea and calcification

Superficial fibromatosis – other sites

Nodule of variably cellular fibroblastic Mitotic figures may be present in

tissue infiltrates an aponeurosis, with cellular regions but are never atypical

bland, uniform spindled cells in a

dense hyalinized collagen stroma

Additional references

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● National Institutes of Health, eMedicine #1; #2, Knol

End of Penis and scrotum > Inflammatory Lesions > Peyronie’s disease

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