Sifa Medical Journal

CASE REPORT
Year
: 2015  |  Volume : 2  |  Issue : 1  |  Page : 24--26

Fibroepithelial polyp of the glans penis


Sunder Goyal, Aseem Trikha, Kartikeya Kashyap, Shveta Narang 
 Department of Surgery, Kalpana Chawla Government Medical College, Karnal, Haryana, India

Correspondence Address:
Sunder Goyal
Department of Surgery, Kalpana Chawla Government Medical College, Karnal - 132 001, Haryana
India

Abstract

Fibroepithelial polyps are a benign growth of mesodermal origin that usually arises in the urinary tract. A 38-year-old man presented with painless polypoid penile mass at tip of penis. He had been using a cloth in the form of pad to clean urine from tip of glans for past 3 years. Wide local excision was done. The histopathologic diagnosis was fibroepithelial polyp. A fibroepithelial polyp of the penis is very rare and is strongly linked with long-term condom catheter use. We present a case of fibroepithelial polyp of the glans that has no link with condom catheter use.



How to cite this article:
Goyal S, Trikha A, Kashyap K, Narang S. Fibroepithelial polyp of the glans penis .Sifa Med J 2015;2:24-26


How to cite this URL:
Goyal S, Trikha A, Kashyap K, Narang S. Fibroepithelial polyp of the glans penis . Sifa Med J [serial online] 2015 [cited 2019 Jun 17 ];2:24-26
Available from: http://www.imjsu.org/text.asp?2015/2/1/24/145822


Full Text

 Introduction



Fibroepithelial polyp (FEP) is a benign mesodermal tumor. Urinary tract polyps mostly arise in ureter and renal pelvis and rarely from the bladder or posterior urethra. These lesions are smooth-surfaced pedunculated mass. The glans penis FEPs differ with regard to their cause, shape, size, and histological features from those of the urinary tract. They are usually large-sized acquired lesions and are strongly linked to long-term condom catheter use or to constant irritation of glans. The pathogenesis of FEPs is unknown. [1],[2] Fibroepithelial polyp if glans penis is extremely rare and countable cases have been cited in the available English literature. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] We present a case of FEP of glans penis without any history of condom catheter use.

 Case Report



A 38-year-old man presented with painless penile mass in outpatients department. He had obstructive urinary symptoms due to pinhole penile meatus for 3 years with urgency/urge incontinence, but he received no medication for his symptoms. He had been using a folded cloth pad to clean urine drops at tip of urethra for 3 years. He use to pinch and massage his glans, but he said that the lesion had been increasing in size from past 6 months. A polypoid-shaped mass was found on the glans penis, primarily involving the tip of glans of the penis with urethral meatus involvement [Figure 1]. The lesion was 3.5 × 3 cm in size. It was a non-tender, solid, and polypoid mass. Polyp was hard in consistency. A wide local excision of polyp was done under local anesthesia along with meatoplasty. There was no communication with the urethra. The excised mass was 3.5 × 3 × 2 cm.{Figure 1}

Histologically, the lesion had a polypoid pattern. The overlying keratinizing squamous epithelium showed acanthosis and hyperkeratosis without koilocytic change. The stroma was edematous, with telangiectasia of pre-existing vessels [Figure 2]. The histopathologic diagnosis of FEP was reported.{Figure 2}

 Discussion



Fibroepithelial polyps are a benign mesodermal growth, which resembles fibromas, leiomyomas, neurofibromas, and hemangiomas clinically and histologically. [4] Usual site in urinary tract is ureter/renal pelvis but rarely can involve the posterior urethra or bladder. [2] The glans penis FEPs are uncommon and differ from those involving the urinary tract in respect of their pathogenesis, shape, size, and histological features.

Most patients have a long-term history of condom catheter use. Fibroepithelial polyps of the glans penis are not always associated with condom catheter use (as in this case). Unusual cases associated with congenital anomaly, paraphimosis, and due to peripheral vascular failure have also been reported. [1],[5],[6] A patient had a 4-month history of lower urinary tract symptoms and developed lymphedematous FEP of the glans penis without any association with long-term condom catheter use. [6] Moreover, a patient carried out genital hanging kung fu for more than 10 years and developed a FEP of glans penis. [9]

Although the pathogenesis associated with condom catheters is not clear, it has been suggested that these lesions are secondary to the negative pressure of the condom catheter and the irritation and inflammation associated with its long-term use, prior penile surgery or secondary to chronic inflammation of glans penis. [8] It is further presumed that the use of a condom catheter decreases vascular and lymphatic drainage and thus results in secondary stromal hyperplasia. Chronic irritation due to urine leak around an ill-fitting device, a maceration or an ulceration may result in polyp formation due to reactive hyperplasia. [2] Why mostly these polyps develop on ventral surface of glans is not clear, but in this case, it developed on tip of glans [Figure 1]. The reactive pathogenesis is less clear in a 4-year-old child as reported by Yildirim et al. [7] [Table 1]{Table 1}

Clinically, they present as painless, hard, polypoid growth of glans on ventral surface (mostly) or on tip of glans as in our case. The differential diagnosis should include acrochordon, condyloma acuminatum, giant condylomas (called Buschke-Lowenstein tumors), verrucous carcinoma, angiomyxoma, and squamous or urothelial carcinoma. [1],[3] Rarely malignant degeneration may occur in penile polyp. [9] Pathologists and urologists should be alert about this unusual complication as giant size polyp can mimic carcinoma. [10]

Fibroepithelial polyps on ventral surface of glans, confined to prepuce, had been reported by Banerji et al, and they differ from conventional cutaneous FEP (also known as skin tags. [11] Rarely, FEP can involve urethra and disturb the voiding. [12] Our case revealed no malignancy, but still a careful examination of these lesions is essential to exclude malignancy. [13],[14]

Our patient had a mass on the tip of the glans penis, near the urethral meatus where, as in literature, mostly these are reported on ventral surface of glans. The median age of patients with such polyps was 40 as in our case the patient is 38 years old.

Treatment with local excision is successful, but in one case, wide excision with suprapubic cystostomy was needed. [13] The prognosis of FEP of glans penis is usually good, but recurrence is possible after local excision.

 Conclusion



The basic process of polyp formation seems to be a reactive hyperplasia due to chronic irritation of glans with urine rather than a true neoplasm. Our patient had no association with condom catheter use. Resection of the polyp is usually curative. As penile FEPs are not seen in all patients who use condom catheters and pads for urinary incontinence, so more work is required to clarify the etiopathogenesis.

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