Journal of the Scientific Society

CASE REPORT
Year
: 2020  |  Volume : 47  |  Issue : 1  |  Page : 41--42

Verrucous hyperplasia of the penis mimicking a malignant lesion


Rajendra B Nerli1, Shridhar C Ghagane2, Sreeharsha Nutalapati3, Priyeshkumar Patel3, Rajeshkumar Gupta4, Neeraj S Dixit2,  
1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed to be University); KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLES Kidney Foundation, Belagavi, Karnataka, India
2 Urinary Biomarkers Research Centre, Department of Urology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
3 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed to be University), Belagavi, Karnataka, India
4 Department of Surgery, B. S. Ayurveda Mahavidyalaya, Savantwadi, Maharashtra, India

Correspondence Address:
Dr. Rajendra B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed to be University), JNMC Campus, Nehru Nagar, Belagavi - 590 010, Karnataka
India

Abstract

Verrucous lesions of the penis are rare and difficult to classify. Superficial biopsy in any of the verrucous lesions shows only hyperkeratosis, acanthosis, and papillomatosis. Therefore, an adequate biopsy is a must to show the rete pegs that extend into the deeper tissues. Deeper biopsies are always required for an accurate diagnosis. These nonneoplastic lesions of the penis need to be differentiated from cancer which is associated with high morbidity. We report a case of a verrucous lesion of the penis in a 38-year-old male.



How to cite this article:
Nerli RB, Ghagane SC, Nutalapati S, Patel P, Gupta R, Dixit NS. Verrucous hyperplasia of the penis mimicking a malignant lesion.J Sci Soc 2020;47:41-42


How to cite this URL:
Nerli RB, Ghagane SC, Nutalapati S, Patel P, Gupta R, Dixit NS. Verrucous hyperplasia of the penis mimicking a malignant lesion. J Sci Soc [serial online] 2020 [cited 2020 Aug 10 ];47:41-42
Available from: http://www.jscisociety.com/text.asp?2020/47/1/41/287495


Full Text



 Introduction



Verrucous lesions of the penis include both nonneoplastic and neoplastic lesions. Nonneoplastic lesions are predominantly of infectious in origin and include condyloma acuminata and simple verrucous hyperplasia (VH). Condyloma acuminata is caused by human papillomavirus (HPV), 90% of which is caused by types 6 and 11 and has a low incidence of tumor development.[1] These nonneoplastic lesions of the penis need to be differentiated from cancer which is associated with high morbidity. The incidence of penile cancer varies between countries and is known to be high in India when compared to the European and North American population. We report a case of a verrucous lesion of the penis in a 38-year-old male.

 Case Report



A 38 year-old male presented to a local surgeon with complaints of inability to retract the prepuce and swelling of the penis. He was examined in detail and circumcision was done. The excised prepuce was not sent for histopathological examination. This patient was fine following the surgery and presented to us 9 months later with the recurrence of swelling on the glans and coronal junction. The lesions were verrucous and surrounded the coronal junction with extension onto the glans at selective areas. These lesions were growing in size. The lesion appeared to be ulcerated on the right lateral part of the glans. The inguinal lymph nodes were bilaterally palpable, small, firm, and nontender. The patient was counseled for excision of the lesion and further treatment if necessary. Uroflow study was normal with Qmax of 15.30 ml/s and postvoid residual of 0 ml.

The patient underwent excision of all the verrucous lesions on the glans and coronal junction. The primary closure of the wound was possible [Figure 1]. The histopathological examination [Figure 2] of the skin revealed acanthosis, hyperkeratosis, and papillomatosis. The dermoepidermal junction showed dense chronic inflammatory infiltrate. There was no evidence of malignant cells in the sections studied. A diagnosis of VH was made. Postoperatively, the wound healed well and the patient was asked to keep on regular follow-up.{Figure 1}{Figure 2}

 Discussion



Verrucous lesions of the penis are rare and not much information exists in literature. Majority of these lesions constitute nonneoplastic and infectious lesions. Among them, condyloma ccuminata is a sexually transmitted disease caused by HPV and commonly affects men between the ages of 20 and 40 years. It presents as a papillary growth at the penile meatus or over the glans. Microscopic examination usually shows complex papillary infoldings of squamous epithelium accompanied by vacuolization of keratinocytes and nuclear abnormality composed of CD4+ Cells. The viruses can be demonstrated by immunohistochemistry and in situ hybridization techniques.[2]

VH occurring in the oral cavity is a premalignant exophytic oral mucosal lesion with a predominantly verrucous or papillary surface and can subsequently transform into verrucous carcinoma (VC), a well-established warty variant of squamous cell carcinoma.[3] As VH and VC are known to present with similar clinical features, these entities need to be distinguished histologically. Similarly, simple VH of the penis is a nonneoplastic lesion showing hyperkeratosis, acanthosi, s and papillomatosis and needs to be differentiated from a penile cancer based on the biopsy and histopathological examination.

Joshi and Ovhal[4] reported on five cases of verruciform xanthoma affecting males who presented with single warty verrucous lesions of 0.5–2 cm size, two in the oral cavity, two on the genital mucosa, and one on the scrotal skin. Histopathology revealed verrucous and papillomatous epidermal hyperplasia with numerous foamy histiocytes packed in the elongated dermal papillae. Columns of deep parakeratosis and neutrophils in the upper spinous layers, with a dermal plasma cell infiltrate, were also noted. Excisions of the lesions were curative, without recurrences. The authors reported that this condition of VH of the penis was rare and very scantily reported in literature.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Pettaway CA, Crook JM, Pagliaro LC. Tumors of the penis. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier, Saunders; 2016. p. 846.
2Sujatha S, Srinivas Kumar V, Durga K. A five year study on differential diagnosis of verruciform penile lesions. Int Arch Integr Med 2017;4:123-7.
3Neville BW, Damm DD, Allen CM, Bouquot JE. Epithelial pathology. In: Oral and Maxillofacial Pathology. 3rd ed. Philadelphia, Pennsylvania, USA: Saunders; 2008. p. 388-97.
4Joshi R, Ovhal A. Verruciform xanthoma: Report of five cases. Indian J Dermatol 2012;57:479-82.