Page 730 - Textbook of Pathology, 6th Edition

714 usually results from lack of cleanliness resulting in
PENIS
accumulation of secretions and smegma. It is a common
NORMAL STRUCTURE accompaniment of phimosis. The type of inflammation may
be acute or chronic, sometimes with ulceration on the
The penis is covered by skin, foreskin (prepuce) and strati- mucosal surface of the glans.
fied squamous mucosa. The structure of penis consists of 3
masses of erectile tissue— two corpora cavernosa, one on Balanitis Xerotica Obliterans
each side dorsally, and the corpus spongiosum ventrally Balanitis xerotica obliterans is a white atrophic lesion on the
through which the urethra passes. The expanded free end of glans penis and the prepuce and is a counterpart of the lichen
the corpus spongiosum forms the glans. sclerosus et atrophicus in the vulva described on page 721.
The lumen of the urethra in sectioned surface of the penis
appears as an irregular cleft in the middle of the corpus TUMOURS
spongiosum. In the prostatic part, it is lined by transitional
epithelium, but elsewhere it is lined by columnar epithelium Benign and malignant tumours as well as certain premalig-
except near its orifice where stratified squamous epithelium nant lesions may occur on the penis. These are discussed
lines it. below:

CONGENITAL ANOMALIES BENIGN TUMOURS

Phimosis Condyloma Acuminatum
Phimosis is a condition in which the prepuce is too small to Condyloma acuminatum or anogenital wart is a benign
permit its normal retraction behind the glans. It may be tumour caused by human papilloma virus (HPV) types 6
congenital or acquired. Congenital phimosis is a developmental and 11. The tumour may occur singly, or there may be
anomaly whereas acquired phimosis may result from conglomerated papillomas. A more extensive, solitary,
inflammation, trauma or oedema leading to narrowing of exophytic and cauliflower-like warty mass is termed giant
preputial opening. In either case, phimosis interferes with condyloma or Buschke-Löwenstein tumour or verrucous
cleanliness and predisposes to the development of secondary carcinoma.
infection, preputial calculi and squamous cell carcinoma. MORPHOLOGIC FEATURES. The condyloma is
Paraphimosis is a condition in which the phimotic pre- commonly located on the coronal sulcus on the penis or
SECTION III
puce is forcibly retracted resulting in constriction over the the perineal area.
glans penis and subsequent swelling. Grossly, the tumour consists of solitary or multiple, warty,
cauliflower-shaped lesions of variable size with exophytic
Hypospadias and Epispadias growth pattern.

Hypospadias is a developmental defect of the urethra in which Histologically, the lesions are essentially like common
the urethral meatus fails to reach the end of the penis, but warts (verruca vulgaris). The features include formation
instead, opens on the ventral surface of the penis. Similar of papillary villi composed of connective tissue stroma
developmental defect with resultant urethral opening on the and covered by squamous epithelium which shows
dorsal surface of the penis is termed epispadias. Hypospadias hyperkeratosis, parakeratosis, and hyperplasia of prickle
and epispadias may cause urethral constriction with cell layer. Many of the prickle cells show clear
Systemic Pathology
consequent infection and may also interfere with normal vacuolisation of the cytoplasm (koilocytosis) indicative of
ejaculation and insemination. Both these urethral anomalies HPV infection.
are more frequently associated with cryptorchidism.
Giant condyloma shows upward as well as downward
growth of the tumour but is otherwise histologically identi-
INFLAMMATIONS
cal to condyloma acuminatum. Though histologically benign,
Glans and prepuce are frequently involved in inflammation clinically the giant condyloma is associated with recurrences
in a number of specific and non-specific conditions. The and behaves as intermediate between truly benign
specific inflammations include various sexually-transmitted condyloma acuminatum and squamous cell carcinoma.
diseases such as hard chancre in syphilis, chancroid caused
by Haemophilus ducreyi, gonorrhoea caused by gonococci, PREMALIGNANT LESIONS (CARCINOMA IN SITU)
herpes progenitalis, granuloma inguinale (donovanosis), and In the region of external male genitalia, three lesions display
lymphopathia venereum caused by Chlamydia trachomatis.
cytological changes of malignancy confined to epithelial
layers only without evidence of invasion. These conditions
Balanoposthitis
are: Bowen’s disease, erythroplasia of Queyrat and bowenoid
Balanoposthitis is the term used for non-specific inflam- papulosis.
mation of the inner surface of the prepuce (balanitis) and
adjacent surface of the glans (posthitis). It is caused by a Bowen’s Disease
variety of microorganisms such as staphylococci, Bowen’s disease is located on the shaft of the penis and the
streptococci, coliform bacilli and gonococci. Balanoposthitis scrotum besides the sun-exposed areas of the skin (page 782).