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Penis and scrotum
Inflammatory lesions
Phimosis
Reviewers: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 21 February 2010, last major update February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Condition in which the foreskin cannot be retracted due to a small orifice
Etiology
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● Usually due to scarring from repeated bacterial infections, lichen sclerosis (Medicina (Kaunas) 2008;44:460), congenitally abnormally long foreskin or chronic graft versus host disease (Bone Marrow Transplant 2007;40:335)
Clinical features
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● Smegma (desquamated epithelial cells, debris) may accumulate, causing secondary infections and possibly carcinoma
● Must liberally sample foreskin to rule out other pathology
● Most young boys who present with tight foreskins have physiologic phimosis, which will generally resolve by adolescence with proper foreskin hygiene (Can Fam Physician 2007;53:445)
Case reports
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● 30 year old with leprosy presenting with phimosis (Indian J Dermatol Venereol Leprol 2009;75:312)
Treatment
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● Circumcision
● Also sutureless prepuceplasty in children (BMC Urol 2008 Mar 4;8:6), betamethasone ointment (Int Braz J Urol 2005;31:370)
Clinical images
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Leprosy presenting Erection with phimosis Distal foreskin is edematous
as phimosis with cracked fissures
Micro description (Histopathology)
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● Fibrosis of lamina propria associated with nonspecific lymphocytic and lymphoplasmacytic infiltrate
● Occasionally mucinous metaplasia in glans and foreskin
● May be associated with underlying lichen sclerosus
● May be associated with epithelial hyperplasia, dysplasia, penile intraepithelial neoplasia or occult early invasive carcinoma
Differential Diagnosis
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● Carcinoma in situ
Additional references
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● Wikipedia, eMedicine #1; #2
End of Penis and scrotum > Inflammatory Lesions > Phimosis
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