Case Reports in Medicine
Volume 2020 (2020), Article ID 6976254, 6 pages
https://doi.org/10.1155/2020/6976254

Case Report

A Huge Penile Fibroepithelial Polyp Treated with Partial Penectomy: A Case Report and Review of the Literature

Adel Alrabadi, Sohaib Alhamss, Yasmeen Z. Qwaider, and Saddam Al Demour

Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan

Correspondence should be addressed to Adel Alrabadi; adelrabadi@yahoo.com

Received 15 July 2020; Revised 28 August 2020; Accepted 31 August 2020; Published 8 September 2020

Academic Editor: Gerd J. Ridder

Copyright © 2020 Adel Alrabadi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Fibroepithelial polyps are benign tumors of mesodermal origin that usually arise on the surface of the skin and to a lesser extent in the urinary tract; however, their presence on the penis is extremely unusual. We report the case of a 73-year-old male with an extremely large broad-based penile fibroepithelial polyp (FEP) involving the penile shaft and glans penis associated with chronic condom catheter use and that was treated with partial penectomy. A review of the literature is included to highlight the rarity of this case. To the best of our knowledge, this is the largest mass of its kind to be reported on the penis.

1. Introduction

Fibroepithelial polyps (FEPs) are benign neoplasms that are mesodermal in origin. Histologically, they have a characteristic squamous epithelial surface with an underlying fibrovascular stroma, and definitive histology is needed to rule out malignancy [1]. We hereby present a case of a huge FEP on the glans penis associated with long-term condom catheter use.

2. Case Report

A 73-year-old male patient presented to our clinic complaining of a painless penile mass which has appeared 4 years ago and gradually been increasing in size. The patient has been known to have urinary urge incontinence for the last 17 years following spinal surgery. Since then, the patient has been using a condom catheter.

As the growth of the mass accelerated over the last 4 months, it became harder for the patient to have good hygiene and the condom could not fit anymore for the huge mass, and so he started to design special plastic bags for that purpose. In addition, the mass itself was becoming a source of a very bad odor. The patient has been complaining of erectile dysfunction, stool incontinence, and bilateral lower limb weakness since the time of spine surgery. The patient has a good urinary stream and has neither dysuria nor hematuria. He reported neither the presence of similar skin lesions, previous penile surgeries (apart from circumcision during childhood), nor a history of recent travels. The patient denied using penile constrictive rings or vacuum devices. There was no history of trauma. He was not taking medication.

On examination, the patient was having a huge (15 × 10 × 8 cm), nontender, “grape-like” penile firm mass originating from the ventral aspect of the penile shaft and glans penis (Figures 1 and 2). The lesion had a very broad base with no stalk. An extremely bad odor was originating from the mass. There was no ulcer and no discharge. The meatal opening, scrotal skin, and both testicles were all normal. The inguinal lymph nodes were not palpable. No other similar skin lesions were found.

Figure 1: Giant fibroepithelial mass measuring at 13 cm on the ventral aspect of the shaft and glans penis.

Figure 2: Giant fibroepithelial mass measuring at 13 cm on the ventral aspect of the shaft and glans penis.

Upon presentation, the serum creatinine level was 2.3 mg/dl. Urine analysis and culture showed the presence of urinary tract infection. The nonenhanced urinary tract computed tomography scan showed bilateral mild hydroureteronephrosis down to the urinary bladder. Ultrasonography showed a postvoid residual volume of 350 cc. 18-French Foley’s catheter was inserted easily and kept in situ. The patient was admitted to the hospital and managed with intravenous fluids and antibiotics. His creatinine became 1.18 mg/dl.

Cystourethroscopy was performed and showed a normal-looking urethra, enlarged prostate, and severe trabeculations of the urinary bladder. At the same time, an incisional biopsy was performed which showed a benign fibroepithelial polyp with no evidence of malignancy. The situation was discussed with the patient and his family. Partial penectomy with excision of the whole mass was performed under general anesthesia. As the lesion was having a very broad base, it was not possible to excise the mass with preserving the penis. The postoperative course was uneventful. Follow-up for two years showed no recurrence.

The final histopathology of the specimen confirmed the previous diagnosis of a benign fibroepithelial polyp with no evidence of malignancy. It showed a hypocellular collagenized, edematous, and vascular stroma. The stroma contained patchy perivascular lymphocytic aggregates. Furthermore, few smooth muscle cell strands were noted. The surface was covered by benign acanthotic stratified squamous epithelium (Figures 3 and 4). Stromal cells were positive for CD34 staining (Figure 5).

Figure 3: A hematoxylin and eosin stain of the fibroepithelial polyp showing a verrucous surface covered by acanthotic stratified squamous epithelium with hyperkeratosis. The stroma is hypocellular and collagenous.

Figure 4: A hematoxylin and eosin stain of the fibroepithelial polyp showing a verrucous surface covered by acanthotic stratified squamous epithelium with hyperkeratosis. The stroma is hypocellular and collagenous.

Figure 5: FEP stromal cells positive for CD34 staining (immunochemistry 200X).

3. Discussion

We have performed a review of the English-written literature using PubMed and Scopus looking for these terms: “fibroepithelial polyp” and “penile fibroepithelial polyp”. The references were reviewed from the available papers and studied. At the end, 25 papers were selected.

To the best of our knowledge, the literature describes only 25 cases of FEPs on the surface of the penis. The age reported in the studies ranged from 25 to 97 years, with the exception of 5 cases reported in children. Eleven of the adult cases, which constitute the majority, reported the long-term use of a condom catheter. 8 adult cases denied the use of the condom catheter. The remaining adult cases practiced male genital hanging kung fu [2]. Other possible causes for the rise of these polyps could be phimosis [1, 3] or the use of a cotton cloth for urinary incontinence [4].

It should also be noted that 17 of the cases occurred on the glans penis, making it the most common site. Other sites of manifestation were either on the frenulum, ventral surface of the penis, or penoscrotal junction (Table 1).

Table 1: Review of the literature, cases of penile fibroepithelial polyps.

Authors
Age
Site
Size
Duration
Condom catheter use
Treatment
Follow-up
Recurrence
Malignancy

Yildirim et al. [5]
4
Glans
7 × 6 mm
NA
No
Local excision + circumcision
NA
NA
No

Fetsch et al. [6]
25
Glans
2.5 cm
Years
Yes
Local excision
13 years 8 months
Local recurrence <1 year. No evidence of disease at 12 years 8 months
No

Fetsch et al. [6]
29
Glans
3.4 cm
6 months
Yes
Local excision
24 years
No recurrence
No

Fetsch et al. [6]
32
Glans
2.5 cm
6 months
Yes
Local excision
1 month
No data
No

Fetsch et al. [6]
40
Glans
2 cm
10 years
Yes
Local excision
8 years 10 months
No recurrence
No

Fetsch et al. [6]
45
NA
3.5 cm
NA
NA
Local excision
Lost to follow-up
NA
No

Fetsch et al. [6]
52
Glans
7.5
1 year
No, paraphimosis
Local excision
6 years 2 months
No
No

Fetsch et al. [6]
58
Glans and prepuce
2.5 cm
NA
Yes
Local excision
3 years 10 months
Local recurrence at 3 years 7 months. No evidence of disease at 3 months (recurrence 2 lesions: 0.9 cm and 3 cm)
No

Emir et al. [7]
97
Distal ventral skin of the penis
5 × 3 cm
Less than 2 years
No
Local excision
NA
NA
NA

Al Awadhi et al. [8]
43
Ventral aspect of penis
4 cm
1 year
Yes (14 years)
Local excisional biopsy
NA
NA
No

Tsai et al. [2]
50
Glans
6.5 × 5 cm
5 years
No (male genitalia hanging kung fu)
Local excision
NA
NA
No

Turgut et al. [9]
59
Ventral aspect of penis
6 × 4.5 cm
10 years
Yes
Wide local excision and anticholinergic agent therapy was begun
1 year
No recurrence
No

Kampanatais et al. [1]
78
Glans
4.5
NA
No (phimosis)
Local excision + circumcision
6 months
No
Yes (SCC)

Pena et al. [10]
63
Glans
3 × 2.5 × 2 cm
NA
No
Local excision
6 months
No
No

Hyun et al. [11]
18 months
Penoscrotal junction
2.9 cm
18 months
No
Local excision
NA
NA
No

Banerji et al. [12]
42
Ventral aspect of the penis
8 × 5 cm
10 years
Yes
Local excision
NA
NA
No

Kim et al. [13]
45
Glans
6 × 3 × 3 cm
NA
Yes
Local excision
12 months
No
No

Mason et al. [3]
36
Glans (frenulum)
1.1 × 1.4 × 2.6 cm
1 year
Yes
Local excision
7 months
No
No

Kampanatais et al. [1]
35
Glans
7 cm
15 months
No
Local excision
60 months
No
No

Rodriguez Collar et al [14]
39
Frenulum
NA
5 months
No
Local excision + circumcision
12 months
No
No

Yan et al. [15]
62
Glans extending to frenulum
7 × 5 × 3 cm
11 years
No
Local excision + circumcision
NA
No
No

Goyal et al. [4]
38
Glans
3.5 × 3 × 2 cm
6 months
No, cotton cloth
Local excision
6 months
No
No

Sencan et al. [16]
6 months
Glans
6 × 7 mm
4 months
No
Local excision
1 year
No
No

Prashant et al. [17]
3
Glans
5 mm × 6 mm
NA
No
Local excision
1 year
No
No

Prashant et al. [17]
4
Glans
NA
NA
No
Local excision
NA
No
No

The overall prognosis of penile FEPs is good, with only 1 of the 25 cases transforming into squamous cell carcinoma [1]. Also, recurrence of the mass was rare with only 2 cases reappearing in less than 3 years (Table 1).

FEPs are benign tumors that arise from the mesoderm [18]. They mostly occur on the surface of the skin, specifically the axillae, neck, and eyelids [7]. In the urinary tract, they are mostly seen in the ureter, renal pelvis, and rarely in the posterior urethra or bladder [17] while their appearance on the penis is a rarity.

The etiology of penile FEPs is generally unknown but has been strongly linked to chronic, improper use of condom catheters [12]. It was hypothesized that pressure from condom catheters results in a reactive process and a decrease in vascular and lymphatic drainage [2, 4]. This theory may also explain the development of the FEP in Tsai et al.’s case report on a patient who practiced pressure-producing male genital hanging kung fu [2]. However, it does not explain the development of similar masses in children and in adults who used noncondom catheter.

Potentially, these FEPs could arise from the irritation of the glans [4], not only by direct pressure but by contact irritation through poor hygiene or cotton cloths.

In relation to the histopathology, all pathology reports from the previously reported cases similarly stated the characteristic fibrovascular edematous stroma covered by keratinized squamous epithelium [1–17]. Also, several authors stated the presence of mast cells [3, 13] and lymphocytes [3, 10, 12]. Our pathological findings were in conjunction with the findings of the literature.

In this reported case, the chronic use of a condom catheter by the patient might have predisposed to the development of the giant mass. It is important to note that the poor quality of hygiene the patient maintained might have played a significant role as well.

It is worth mentioning that upon the revision of the related literature, the current case we present has the largest mass recorded and at a maximum diameter of 15 cm. Partial penectomy was indicated in the case of our patient due to the replacement of the penile shaft and surrounding skin with the mass. Local complete excision of the mass with preserving the penis was impossible for us. We believe this procedure has never been performed in the case of a penile FEP according to the published data.

Finally, the postoperative course of the patient was uneventful; hence, we conclude that wide local excision and partial penectomy can be a good and satisfactory treatment option in the case of large polyps such as this. Additionally, our patient might solidify the theory that chronic, improper use of a condom catheter may predispose to the development of penile FEP. The role of hygiene should be noted as well and mentioned to all patients using condom catheters.

4. Review of the Literature

4.1. Methods

We underwent a review of the English-written literature using PubMed looking for the term: “penile fibroepithelial polyp”. Besides, we reviewed the references of the available articles.

4.2. Results

About 25 cases of a penile fibroepithelial polyp were reported in the literature (Table 1).

Data Availability

The data used to support the study are included within the article.

Ethical Approval

The study complies with the guidelines for human studies and was conducted in accordance with the World Medical Association Declaration of Helsinki.

Consent

The subject has given his written informed consent to publish his case including publication of images.

Conflicts of Interest

All authors declare that they have no conflicts of interest.

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