Atypical Peyronie’s disease

Abstract

A 36-year-old man presented with a 6-month history of a painful 3×4 cm mass in the perineum. There was no associated history of trauma, erectile dysfunction, penile deformity or urinary symptoms, and he was not a cyclist. On examination a tender fixed mass was found in the region of the crus of the left corpora cavernosum. A diCerential diagnosis at this stage included rhabdomyosarcoma or other mesenchymal neoplastic growths, including an epitheloid sarcoma [1]. Ultrasonography confirmed a perineal mass with invasion into the crus of the left corpus cavernosum (Fig. 1). Subsequent CT was not helpful. A wedge biopsy of the mass revealed hyalinized fibrous tissue in which occasional blood vessels were cuCed by chronic inflammatory cells. There was extension of the fibrous tissue into the superficial erectile tissue consistent with Peyronie's disease. The patient was treated for 9 months with tamoxifen, with resolution of the pain and a reduction in the size of the mass, and with preservation of erectile function. penoscrotal junction. A urethrogram revealed a normalcalibre urethra but with an area of calcification on its dorsal surface. Urethroscopy revealed that this abnorComments mality was not within the urethral wall. At exploration via a midline penoscrotal incision, the corpus sponPeyronie's disease was described in 1743, yet its aetiology remains unknown. The plaque is located on the giosum was mobilized to provide access to a hard midline mass at the junction of the crura within the septum of dorsal surface of the penis in 66% of cases, laterally in 20%, ventrally in 6% and within the septum in 6% the tunica albuginea. The histology of this lesion revealed bone in a Peyronie's plaque (Fig. 2). Postoperatively, the [2,3]. The reported location of the plaque is fairly evenly distributed along the pendulous part of the penis, in erectile diBculties persisted, with a slight left deviation of the erect penis, although he could still obtain and several series [2-4]. Peyronie's disease has never been described in the crus of the penis. These two cases show maintain erections suBcient for penetration and therefore did not want further surgery.that the plaque can occur in any part of the tunica 537

Clinical presentations of Peyronie's disease

“…It is rare to find a plaque in the perineum. 14 The number of plaques vary but in most men only one plaque is felt (78% of 250 men 2 or 84% of 111 men 4 ).…”