Epithelioid sarcoma of the penis—a rare differential diagnosis of Peyronie's disease

Current and Future Directions of Technology in Assessment of Peyronie's Disease

PURPOSE OF REVIEW

This review assesses the effectiveness of various imaging modalities for diagnosing and managing Peyronie's disease (PD), exploring their clinical utility and limitations.

RECENT FINDINGS

Ultrasonography, currently the only modality endorsed by the American Urological Association, effectively detects calcifications and assesses vascular status but struggles with identifying non-palpable plaques. Computed tomography and magnetic resonance imaging provide detailed anatomical views but are costly along with other deterring factors. Autophotography and 3-dimensional imaging offer convenient home assessments but with variable accuracy. Elastography improves upon traditional ultrasonography, while emerging AI technologies show promise for automating precise curvature assessments, pending further validation. A combined approach tailored to each individual patient based on their needs enhances diagnostic accuracy. Supplementing ultrasonography with elastography and potentially AI could improve diagnostic outcomes and better guide treatment decisions. Continued research is vital to integrate these advancements into standard clinical practice and develop updated standardized protocols.

Evaluation and Treatment of Penile Thrombophlebitis (Mondor's Disease)

Superficial penile thrombophlebitis or penile Mondor's disease (PMD) is an underreported condition that causes anxiety and embarrassment in affected men. Patients usually present with a smooth, cord-like induration on the dorsal penile shaft 1-7 days after prolonged or intensive sexual intercourse, but other presentations of disease and triggers for endothelial damage are possible. The condition is typically self-limited with expected spontaneous resolution within 4-8 weeks of initial presentation, and absolute diagnosis is usually not necessary with management including supportive care and pain control. However, when disease course is prolonged or there are concerning risk factors, it may be important to differentiate PMD from other conditions such as Peyronie's disease, hypercoagulability, blood stasis, genitourinary infection, and malignancy. History and physical are often sufficient to distinguish these conditions from PMD, but providers may employ ultrasound to assist with the diagnosis. If PMD does not spontaneously resolve, patients may be considered for thrombectomy, at which point histological analysis can confirm the diagnosis.

Granuloma annulare of the penis: a uncommon location for an usual disease

The subcutaneous clinical variant of granuloma annulare (GA) is rare and tends to present more frequently in children, in locations unusual for conventional GA. Involvement of the penis is exceptional and has been rarely reported. Most cases are located in the shaft of the penis and tend to persist without spontaneous remission. Diagnosis is done only after biopsy, and surgical resection of the lesions is not unusual. We report a new case of subcutaneous GA of the penis in a 13-year-old boy with lesions persistent for the past year. Surgical excision of one of them allowed the correct diagnosis. No further treatment was done, and the condition has not remitted 1 year later. We stress the importance of clinical recognition of unusual presentations of GA to avoid overtreatment of lesions that do not need an aggressive approach.

Three-chamber priapism in a patient with primary epithelioid hemangioendothelioma of penis

A 58-year-old man presented with a 6-month history of painful progressive penile firmness, initially diagnosed as Peyronie's disease. Penile fibrosis involved the entire corpora cavernosa and spongiosum, making it consistent with three-chamber priapism. Cavernosal biopsies revealed epithelioid hemangioendothelioma, and the metastatic workup found hepatic and pulmonary lesions. The patient was treated with paclitaxel, but eventually died of cancer progression. Early infiltrative vascular malignancies of the penis may be indistinguishable from Peyronie's disease. A review of published reports revealed that penile masses associated with progressive growth, obstructive urinary symptoms, dysuria, or painful erections might warrant further evaluation with biopsies.