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Keywords:

  • corpus cavernosum;
  • leiomyoma;
  • penis

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Abstract:  While soft tissue tumors can occur in the penis, corpus cavernous tumors are rare. Reported cases of corpus cavernous tumors are from metastases of advanced malignancy, such as cancers of the bladder, prostate, rectosigmoid colon, kidney, pancreas, liver, testis and nasopharynx. Primary corpus cavernous tumors are extremely rare and have possibly never been reported before. Herein, we report a case of leiomyoma of the corpus cavernosum. After the diagnosis of leiomyoma was established, total excision of the tumor was not attempted and the tumor remained unchanged in size and shape over a follow-up period of 15 months.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Both benign and malignant soft tissue tumors of the penis have been reported and these tumors usually occur outside the corpus cavernosum.1 Corpus cavernous tumors are rare and most of them are metastases from advanced malignant diseases.2–4 To our knowledge, primary tumors of the corpus cavernosum are extremely rare and have possibly never been reported before. We report a case of leiomyoma of the corpus cavernosum in the penis of a 20-year-old man.

Case report

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

A 20-year-old man noticed a mass over his distal penis shaft approximately 3 months before visiting our urological clinic in 2003. The indurated mass caused neither pain nor penile angulation and did not affect erection or interfere with sexual intercourse.

On physical examination, a marble-sized, rubbery, painless and smoothly surfaced mass embedded in the left distal corpus cavernosum near the coronary sulcus could be palpated. Magnetic resonance imaging (MRI) scanning confirmed the presence of a left corpus cavernous tumor measuring 1.9 cm × 1.4 cm × 1.2 cm in size (Fig. 1). Laboratory data were not remarkable.

image

Figure 1. The oblique sagittal T2-weighted image (TR/TE = 3600/91) shows a hypointense mass in the distal part of the left corpus cavernosum in contrast to the normal intensity of the rest of the corpus cavernosum and the corpus spongiosum.

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Surgical exploration disclosed a grayish white and elastically firm mass occupying almost the entire left distal corpus cavernosum. Biopsies with deep bites were carried out. Pathological results revealed a leiomyoma composed mainly of smooth muscle cells and abundant vascularity (Fig. 2).

image

Figure 2. Microscopic specimen reveals a tumor composed of smooth muscle cells mixed with prominent vascularity. Hematoxylin–eosin staining reduced from ×100. The inset shows desmin-positive smooth muscle cells. Avidin–biotin–peroxidase complex (immunohistochemistry stain) reduced from ×100.

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After the biopsies, the wound healed quickly and the patient resumed his sexual life uneventfully. He was followed up for 15 months and the tumor size and shape had not noticeably changed over this time as demonstrated by a follow-up MRI carried out 15 months later (Fig. 3).

image

Figure 3. The follow-up magnetic resonance imaging scan carried out 15 months later shows that the left corpus cavernous tumor is almost the same size and shape as the previous image.

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Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Soft tissue tumors, both benign and malignant, can occur in the penis.1 Examples of benign tumors are hemangioma, lymphangioma, neurofibroma, neurilemoma and leiomyoma, and examples of malignant tumors are malignant hemangioendothelioma, Kaposi’s sarcoma, leiomyosarcoma, fibrosarcoma, malignant schwannoma, lymphoma and undifferentiated sarcoma.1 In general, these soft tissue tumors of the penis are located subcutaneously and rarely involve the corpus cavernosum.1

Reported corpus cavernous tumors are mainly from metastases of genitourinary malignancies, such as bladder and prostate cancer.5–8 Other reported sources of metastases to the corpus cavernosum include cancers of rectosigmoid colon, kidney, pancreas, liver, testis and nasopharynx.2–9 As penile metastases generally represent advanced stages of the primary diseases, prognoses are poor and patients seldom live for more than 6 months.

To the best of our knowledge, primary tumors of the corpus cavernosum have not been reported before. While one case of primary lymphoma of the penis with suspicious involvement of the tunica albuginea of the left corpus cavernsum was reported a few years ago, it was not a true corpus cavernous tumor.10 The current patient is very likely to be the first reported case of leiomyoma of the corpus cavernosum of the penis.

Leiomyoma is a benign lesion of smooth muscle origin. Reported leiomyomas of the penis arise either from the glans penis or from subcutaneous areas and some of them grow steadily.11,12 Careful pathological analyses to identify pleomorphic, hyperchromatic and mitotic characteristics of malignancy, together with immunohistochemical techniques to provide evidence of actin or vementin molecules within the tumor cells, are of value in differentiating leiomyoma from leiomyosarcoma.11,12

After the diagnosis of leiomyoma was established for the corpus cavernous tumor in the present patient, total excision of the tumor was not attempted for fear of jeopardizing the young patient’s erectile function. Over a follow-up period of 15 months, the tumor size and shape have remained the same and the patient has not being appreciably bothered by the presence of the tumor. Further follow up is nevertheless advised for the current patient because leiomyoma has the potential of increasing in size progressively.

In summary, we report the first case of leiomyoma of the corpus cavernosm. A cavernous tumor, particularly in a young male, can still be benign and radical treatment can be deferred when no progression and symptoms are noted.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References