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At least 181 records · Page 10Linked to original sources
PubMed2004

Epithelioid hemangioma of the penis: a clinicopathologic and immunohistochemical analysis of 19 cases, with special reference to exuberant examples often confused with epithelioid hemangioendothelioma and epithelioid angiosarcoma.

Epithelioid hemangiomas of the penis are very rare. To date, less than 10 examples have been reported in the English language literature. In this report, we describe the clinical, histopathologic, and immunohistochemical findings in 19 cases retrieved from our files. The patients ranged in age from 23 to 75 years (median age, 45 years) at the time of initial surgical resection. Seventeen patients presented with a solitary mass, and two presented with two separate, but closely approximated, lesions. The process involved the glans penis (n = 3), shaft (n = 11), base of the penis (n = 2), or penis, not otherwise specified (n = 3). The lesions ranged in size from <0.5 to 2.5 cm (median size, approximately 1.2 cm) in greatest dimension. Eleven examples were specifically noted to be dorsally located, and only one was stated to be ventral. Localized pain or tenderness was the most common complaint, documented in 12 cases. The preoperative duration of the lesions ranged from 5 days to 1 year (median 4.5 months). Microscopically, all examples contained a tumefactive proliferation of epithelioid endothelial cells, often in a nodular or lobular configuration and associated with an inflammatory infiltrate containing lymphocytes and eosinophils. In 14 cases, the vascular proliferation was associated with a small arterial segment, sometimes with mural damage and frequently (n = 13) with intraluminal epithelioid endothelial cells. Based on the growth pattern of the epithelioid endothelial cells, 13 cases were considered "typical," and six were considered exuberant or "atypical." The latter examples had a prominent centrally located zone where nests or sheet-like aggregates of epithelioid endothelial cells did not form discrete vessels. Immunohistochemical data are available for 15 tumors. The epithelioid endothelial cells usually had strong reactivity for CD31, lesser reactivity for factor VIIIrAg, and minimal reactivity for CD34. In 9 of 12 cases, a small number of epithelioid endothelial cells expressed keratins. In all cases tested, at least focal muscle-specific actin-positive myopericytic cells were present bordering the endothelial cells, and this was especially notable peripherally. Initial surgical intervention consisted of either a shave biopsy (n = 1), excisional biopsy (n = 2), or local excision (n = 16). A complete follow-up history is available for 12 patients, and incomplete follow-up information is available for an additional four patients. One patient developed a new epithelioid hemangioma at a site within the penis separate from the initial lesion, but no patient is known to have experienced a true metastasis or to have died of complications of this process. Optimal management appears to be complete local excision with periodic follow-up visits to monitor for local recurrence.

Adult↗
PubMed2006

Surgical treatment of lymphedema of the penis and scrotum.

PURPOSE: Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. MATERIALS AND METHODS: Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. RESULTS: Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. CONCLUSIONS: The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.

Adolescent↗
PubMedDate not supplied

Penile prolapse and urethral obstruction secondary to lymphosarcoma of the penis in a dog.

A 5-year-old Chihuahua presented for clinical signs of dysuria and penile prolapse. Radiographic studies identified a urethral obstruction distal to the junction of the proximal and middle third of the os penis that appeared to be secondary to swelling of the penis. Penile resection combined with a scrotal urethrostomy was performed. Histopathological examinations of tissue samples of the body of the penis revealed lymphosarcoma. Lymphosarcoma of the penis is a rare finding in all species. It can occur as a primary tumor of the penis in dogs. Penile lymphosarcoma should be considered in the differential diagnosis of dogs affected with penile prolapse and dysuria.

Animals↗
PubMed2002

[Carcinoma in situ of the penis rapidly progressing after carbon dioxide laser treatment].

Laser treatment is considered to be effective in treating carcinoma in situ of the penis. We, however, report a case with carcinoma in situ of the penis which developed invasive carcinoma and inguinal lymphnode metastases only 6 months after the laser treatment. A 74-year-old man with pseudophimosis presented with redness of the glans penis. A physical examination revealed thick erythema, 12 millimeters in diameter, around the external urethral meatus. Histologically, biopsy revealed squamous cell carcinoma in situ. No metastasis was suspected by physical examination and imaging studies. Although the lesion appeared to slightly extend into the urethra, it was primarily treated with the CO2 laser. Six months after the treatment, however, local recurrence was confirmed by the touch smear cytology, resulting in the partial amputation of the penis. The histopathological examination revealed subepithelial and marked lymphatic invasion of the tumor and positive margin in the urethral stump (squamous cell carcinoma in situ). Further, since bilateral superficial inguinal lymphnode swelling appeared, total amputation of the penis with perineal urethrotomy and pelvic/inguinal lymphnode dissection was performed subsequently. The metastases to bilateral inguinal lymphnodes were confirmed histologically. The patient received adjuvant chemotherapy and has been alive and well without evidence of disease 40 months after the initial treatment.

Aged↗
PubMed1995

[Kaposi's sarcoma of the penis: our experience and review of the literature].

OBJECTIVES: The present study reports our experience and the results achieved in the treatment of Kaposi's sarcoma of the penis. To date, only 53 cases of this uncommon pathology have been reported in the literature. The different therapeutic alternatives are discussed. METHODS: Three cases of Kaposi's sarcoma of the penis were referred to our department for evaluation and treatment. In two cases we performed palliative surgery (partial excision of penis and circumcision) for the urological symptoms and the third case received chemotherapy. RESULTS: The course of the disease was torpid. At 6 months the patient who had undergone partial excision of the penis showed tumor recurrence, there was scant response in the patient who had received chemotherapy and the outcome was poor in the patient that had undergone circumcision due to the general condition of the patient. CONCLUSIONS: Kaposi's sarcoma of the penis is an uncommon lesion that usually presents in male homosexuals with AIDS. Different therapeutic options are available and some of them have been shown to be effective, although the results depend on the patient's general condition.

Adult↗
PubMed1976

Penis envy: from childhood wish to developmental metaphor.

Two phases of penis envy are considered. The first regularly occurs early in development and is registered as a narcissistic injury which can be resolved under optimal conditions and can contribute to female psychosexual development. If, however, it is not favorably resolved or, even more significantly, if the basic character disorder is of a narcissistic type, the awareness of the genital difference becomes one of many narcissistic traumas. A later phase of penis envy usually represents a regressive effort to resolve oedipal conflicts. In the past, these two phase-oriented forms of penis envy have not been adequately distinguished. Two clinical examples are presented in which the envy of men was only part of a tendency to envy in a narcissistic character disorder. In the analysis, the interpretation of the penis envy offered a metaphor around which all of the "free-floating" envy could coalesce. The cases illustrate the necessity to consider penis envy as the manifest content of a symptom that needs analysis, rather than as "bedrock" or ultimate conflict.

Adult↗
PubMed1977

[Malignant melanoma of penis].

Two cases of malignant melanoma of the penis are reported. A further case report of a naevus caeruleus of the glans penis is presented with regard to the differential diagnosis of malignant melanoma of the penis. A comprehensive review of the literature has revealed 41 case reports of malignant melanoma of the penis. A brief characterisation of malignant melanoma of the penis is given.

Adult↗
PubMed1997

The sensory branch of the pudendal nerve is the major route for adrenergic innervation of the penis in the rat.

BACKGROUND: Multiple pathways have been proposed for the course of adrenergic fibers to the penis and, although it is generally recognized that the pudendal nerve (PudN) is the most important, there is little quantitative information available. METHODS: We used image analysis of catecholamine histofluorescence to quantify the effect of various nerve lesions on the adrenergic innervation of the rat penis. In addition to the denervation studies and as a direct test of whether penile adrenergic fibers traversed the pelvic plexus, penile neurons in the sympathetic chain were first labeled with a retrograde dye placed in the penis. The cavernous nerve of these animals was later exposed to another dye with different spectral characteristics. RESULTS: Interruption of the sensory branch of the PudN reduced adrenergic innervation of cavernosal smooth muscle by 86% (+/- 2.5%). Vascular fibers of the deep penile and helicine arteries were also severely reduced but not entirely eliminated. Interruption of the motor branch of the PudN had a lesser and more variable effect on penile adrenergic innervation: a 21.2% (+/- 6.8%) decrease in cavernosal muscle innervation but no obvious affect on vasomotor fibers. Combining the nerve lesions with phenol degeneration of perivascular fibers of the pudendal vessels further reduced but did not entirely eliminate adrenergic fibers in the cavernosal muscle and penile vessels. CONCLUSIONS: The dramatic reduction of adrenergic innervation of the penis after section of the PudN, especially the sensory branch, and the absence of double-labeled neurons in the sympathetic chain suggest that the PudN nerve is the major, if not the exclusive, pathway by which adrenergic fibers reach penile erectile tissue of the rat.

Adrenergic Fibers↗
PubMed1989

Immunohistochemical characterization of pelvic neurons which project to the bladder, colon, or penis in rats.

Retrograde-tracing and immunohistochemical techniques were used in combination to investigate the types of putative transmitters in pelvic neurons that project to the bladder, colon or penis of rats. In addition, populations of axon varicosities associated with these neurons were characterized. Subpopulations of neurons in colchicine-treated major pelvic ganglia and accessory ganglia of male rats contained immunoreactivity (IR) for tyrosine hydroxylase (TH), vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), or enkephalin (ENK), while types of immunoreactivity found in major groups of varicose axons were ENK, cholecystokinin (CCK), and somatostatin (SOM). Substance P (SP)-IR varicose axons were much less common. Bladder and colon neurons were similar in a number of ways. Many neurons contained NPY-IR (greater than or equal to 50%), fewer contained TH-IR (25-30%), and even fewer contained ENK-IR (5-15%) or VIP-IR (5-10%); many neurons were associated with baskets of ENK-IR varicosities (50-65%) and fewer neurons were surrounded by CCK- or SOM-IR varicosities (30-35%). Colon neurons differed from penis neurons in having a slightly larger proportion that contained ENK-IR (10-15%, compared with 1-3%). Penis neurons were markedly different from the other two groups in additional ways. More than 90% of them contained VIP-IR, whereas only 5-7% contained NPY-IR and none were immunoreactive for TH. Furthermore, although the proportion of penile neurons associated with many ENK-IR varicosities was similar to the bladder and colon neurons (45-50%), they were rarely seen close to CCK- or SOM-IR varicose axons. These studies describe similarities and differences in the histochemical properties of neurons which project to the bladder, colon, or penis and of the varicose axons associated with those neurons. This gives further insights into the possible transmitter mechanisms involved in the regulation of different pelvic functions.

Animals↗
PubMed1991

Topography and ultrastructure of sensory nerve endings in the glans penis of the rat.

The aim of the present study was to describe the types and location of sensory nerve endings in the glans penis of the rat on the basis of light and electron microscopy. Free nerve endings are abundant throughout the glans and are derived from either thinly myelinated A delta or unmyelinated C fibers. The free nerve endings derived from A delta fibers often extend into the epidermis as far as the granular layer and exhibit buttonlike terminal thickenings. The distal urethra contains many free nerve endings from C fibers. Numerous lamellated corpuscles are present. Each corpuscle, innervated by one or two medium diameter myelinated nerve fibers, consists of 4-10 spiralling and intertwined inner cores enveloped by Schwann cell lamellae. The corpuscles are usually enclosed by a perineural capsule, although some located near the epidermis lack a capsule. Lamellated corpuscles in the superficial dermis are located adjacent to but not directly under a penile spine and change their orientation when the glans is erect. The dermal papillae of the penile spines are devoid of any neural structure. Lamellated corpuscles are also located within the trabeculae of the corpus spongiosum glands and in the lamina propria of the urethra. Occasionally, unmyelinated nerve bundles are seen inside these corpuscles. Ruffini corpuscles are few in number and are located in the deep connective tissue near the os penis. They have an incomplete connective tissue capsule and the nerve terminals are anchored between collagen fiber bundles. No Merkel nerve endings, Meissner, or Vater-Pacini corpuscles were found in any of the sections. We conclude that the glans penis of the rat contains a sensory receptor complement that is generally similar to the human glans penis but is unlike the glabrous and hairy skin.

Animals↗
PubMedDate not supplied

Anatomy of the human penis: the relationship of the architecture between skeletal and smooth muscles.

To investigate the anatomy of the ischiocavernosus muscle, bulbospongiosus muscle, and tunica albuginea and to determine their relationships to smooth muscle, which is a key element of penile sinusoids, we performed cadaveric dissection and histologic examinations of 35 adult human male cadavers. The tunica of the corpora cavernosa is a bilayered structure that can be divided into an inner circular layer and an outer longitudinal layer. The outer longitudinal layer is an incomplete coat that is absent between the 5-o'clock and 7-o'clock positions where 2 triangular ligamentous structures form. These structures, termed the ventral thickening, are a continuation of the anterior fibers of the left and right bulbospongiosus muscles. On the dorsal aspect, between the 1-o'clock and 11-o'clock positions, is a region called the dorsal thickening, a radiating aspect of the bilateral ischiocavernosus muscles. In the corpora cavernosa, skeletal muscle contains and supports smooth muscle, which is an essential element in the sinusoids. This relationship plays an important part in the blood vessels' ability to supply the blood to meet the requirements for erection, whereas in the corpus spongiosum, skeletal muscle partially entraps the smooth muscle to allow ejaculation when erect. In the glans penis, however, the distal ligament, a continuation of the outer longitudinal layer of the tunica, is arranged centrally and acts as a trunk of the glans penis. Without this strong ligament, the glans would be too weak to bear the buckling pressure generated during coitus. A significant difference exists in the thickness of the dorsal thickening, the ventral thickening, and the distal ligament between the potent and impotent groups (P < or =.01). Together, the anatomic relationships between skeletal muscle and smooth muscle within the human penis explain many physiologic phenomena, such as erection, ejaculation, the intracavernous pressure surge during ejaculation, and the pull-back force against the glans penis during anal constriction. This improvement in the modeling of the anatomic-physiologic relationship between these structures has clinical implications for penile surgeries.

Adult↗
PubMed1991

Dorsal nerve of the penis nerve conduction velocity: a new technique.

In the evaluation of a possible peripheral neuropathic process as the etiology of erectile dysfunction, studies of the dorsal nerve of the penis may be unique in that they allow examination of the most distal segment of pudendal nerve in isolation. This study describes a new technique using a simple traction device for elongation of the penis to determine the orthodromic nerve conduction of the dorsal nerve of the penis. With stimulation at the glans, and recording at the base of the penis, the value obtained in 20 normal subjects was 36.2 +/- 3.2 m/s with an amplitude of 2.29 +/- 1.08 mV.

Adult↗
PubMed1991

Distribution and origin of neuropeptide Y-immunoreactive fibers in the penis of the rat.

The present study investigated the distribution of neuropeptide Y-immunoreactive fibers to the penis of the rat. In the corpora cavernosa penis, a dense plexus of fibers was associated with arteries, intrinsic cavernosal muscle, and veins, including the deep dorsal vein. In the corpus spongiosum, immunoreactive fibers were present around vascular smooth muscle and at the periphery of the acini of the paraurethral glands. Immunohistochemistry of penile neurons identified by retrograde tracer injection into the penis indicates that about 5% of the penile neurons in the pelvic plexus contained the neuropeptide while larger percentages of penile neurons in the sympathetic chains were immunoreactive for neuropeptide Y. Chemical and surgical sympathectomy greatly reduced the neuropeptide Y- and catecholamine-containing fibers in the erectile tissue but had no clear effect on the neuropeptide Y fibers around the paraurethral glands; a tissue that is not innervated by adrenergic fibers. It is concluded that (1) the widespread distribution of neuropeptide Y indicates that it may function in the control of penile blood flow, (2) with the possible exception of the paraurethral glands, the sympathetic chain is the most likely source of neuropeptide Y fibers in both erectile bodies of the penis, and (3) this peptide may play a role in the secretory functions of the paraurethral glands.

Animals↗
PubMed2000

[Leiomyoma of the glans penis].

Glans penis leiomyomas are uncommon as primary nonepithelial tumors of the urogenital tract. Only 4 cases are described until today. We saw an other case of an 12 years old boy with a leiomyoma of the glans penis. Clinically the lesion presented as a yellow induration with no symptoms as pain, pruritus or bleeding. The biopsy revealed histological a leiomyoma in the subcutis of the glans penis with no symptoms of malignancy. Because of suspected functional and cosmetic deficiency a total resection was not performed. None of the cases described in the literature showed in the follow up malignancy or recurrency. 18 months postoperatively our patient is furthermore well and without symptoms. Nevertheless the leiomyoma of that localization is rare, this tumor should be included in the differential diagnosis of the neoplasms of the glans penis.

Child↗
PubMed1994

Differential distribution of nitric oxide synthase in neural pathways to the urogenital organs (urethra, penis, urinary bladder) of the rat.

Axonal tracing techniques were used in combination with histochemical methods (NADPH-diaphorase activity and nitric oxide synthase immunoreactivity) to examine the distribution of nitric oxide synthase (NOS) in the neural pathways to the urogenital organs of the male rat. The major goal of this study was to compare the histochemical properties of the efferent and afferent neurons innervating the urethra with the properties of neurons innervating the penis and bladder. In the major pelvic ganglion (MPG) large percentages of postganglionic neurons innervating the urethra (44%) and the penis (97%) exhibited NADPH-diaphorase (NADPH-d) staining whereas only a small percentage (3.5%) of neurons innervating the bladder were N-d positive. Urethral neurons stained for N-d were on average smaller (33.3 microns diameter) than unstained neurons (54.5 microns diameter). The histochemical difference between the three types of neurons was also reflected in NOS-immunoreactivity (IR); however, the absolute percentage of neurons exhibiting NOS-IR was low: penis (21%), urethra (11%) and bladder (0%). Axonal varicosities staining for N-d or NOS-IR were noted in the MPG in close proximity to unidentified neurons and neurons innervating the urogenital organs. A considerable number of afferent neurons in the lumbosacral dorsal root ganglia (DRG) stained for N-d (64 cells/L6, 35 cells/S1 section); however, only small numbers of neurons (average 1 cell/section) exhibited NOS-IR. N-d activity was detected in a large percentage of urethral (55%) and bladder (80%) afferent neurons in the L6-S1 dorsal root ganglia (DRG) but in relatively few (12%) penile afferent neurons in the L6 ganglia. These results suggest that the contribution of nitric oxide (NO) to neurotransmission varies considerably in different urogenital organs. NO could have a significant role in postganglionic efferent pathways to the urethra and penis but very likely has no role in the efferent pathways to the bladder. Similarly, the prominence of N-d staining in some DRG neurons (e.g. urethra and bladder) but not others (penile) also raises the possibility of a varying role of NO in afferent pathways. However, in these neurons N-d staining was not paralleled by NOS-IR, which was present in only a small percentage of neurons. Thus, N-d staining may not reflect the presence of NO in afferent pathways to the pelvic viscera.

Afferent Pathways↗
PubMed1990

Immediate reconstruction of the penis with an iliac flap.

Immediate reconstruction of the penis can save time and significantly reduce postoperative psychological morbidity. A patient suffered a cancerous lesion in his glans penis. After total amputation, an iliac flap based on the superficial circumflex iliac artery was used to reconstruct the penis. The subcutaneous tissue around the vascular pedicle was carefully preserved for enhancing the venous drainage of the new penis. A self-sculptured silicone implant was inserted later to increase the penile rigidity. The advantages of this technique include ready availability, easy mobilisation, hairlessness, elimination of multi-staged procedures, and saving time. The patient is pleased with the operative results.

Amputation, Surgical↗
PubMed1990

Reconstruction of penis with free deltoid flap.

Two cases of reconstruction of the penis with a free deltoid flap are described. The urethra was reconstructed with part of the flap and external coverage of the penis was provided with the remainder. In one case an autogenous rib cartilage graft was inserted in the reconstructed penis as a strut. Postoperatively both patients can urinate standing up, and for the one in which a rib cartilage graft was used sexual intercourse is possible. Both cases have good recovery of tactile and protective sensation in their reconstructed penis.

Adult↗
PubMed1987

Surgical treatment of the "buried" penis.

The "buried penis" occurs in a spectrum which varies from slight with only ventral webbing to almost complete burying of the penis dorsally in the prepubic fat pad and ventrally in the scrotum. From 1979 to 1985, the author operated on 80 children with these problems. Indications for surgery varied from unsatisfactory appearance of the penis before or after circumcision to almost complete concealment of the penis. Satisfactory cosmetic and functional results were achieved in most cases utilizing several surgical principles. The limitations of these procedures and their possible complications are described.

Adipose Tissue↗