Pathologic
calcification or ossification refers to the process by which calcium
salts build up in soft tissue, causing it to harden and form
extraskeletal bone. This may result from a malignant infiltrative
process, hypercalcemia secondary to a paraneoplastic syndrome, end stage
renal disease, calcium-phosphate abnormalities caused by
hyperparathyroidism or other metabolic derangements, or from a local
metaplastic process resulting from repeated trauma or a chronic
inflammatory state.
Ossification occurring in the human
penis is exceedingly rare, with fewer than 40 cases reported. Another
related condition, “congenital human os penis,” is also extremely rare,
with only 1 reported case in a 5-year-old boy.
Ossification of the penis is most commonly due to Peyronie’s disease, a
chronic inflammation of tunica albuginea that leads to penile fibrosis.
The hardened plaque reduces flexibility and leads to a penile bend or
curvature during erection. Less common etiologies of penile ossification
have been reported, including local trauma to the penis, chronic
hemodialysis in patients with end-stage renal disease, chronic
inflammatory states as in syphilis and gonorrhea, and with general
metabolic disorders such as gout and diabetes.
Case report
A
54-year old gentleman presented to the urology office with a 1-year
history of a painless hard proximal penile masses involving one-third
the length of his corporal bodies bilaterally. He was neither sexually
active nor bothered by symptoms from this penile lesion; he presented,
however, for workup concerning the possibility of malignancy. The
patient denied any history of trauma or family history of genitourinary
malignancy. He also denied penile pain, dysuria, irritative voiding
symptoms or any other subjective complaints. To the patient’s knowledge,
the hard mass had been present for several years and gradually
increased in size over time.
Physical examination
revealed a mobile, rock-hard, calcified mass palpable at the base of the
penis circumferentially involving both proximal corpora. Digital rectal
examination was normal and no inguinal nodes were palpable on
examination. Results from routine laboratory evaluations were normal. A
magnetic resonance imaging of the pelvis with gadolinium failed to
identify any corporal abnormalities, and no pelvic lymphadenopathy was
seen on imaging.
At this point, the
decision was made to perform a cystoscopy and excisional biopsy of the
calcified mass at the base of the penis. Cystoscopy revealed a normal
urethra, bladder mucosa, and prostate, confirming that the plaque was
external to the urethra. After degloving the phallus, the hard calcified
proximal corpora were easily palpated and felt to be entirely replaced
by a calcific process. An excisional biopsy was performed of the right
corpora, with minimal bleeding noted from the calcified corporal body.
Histological examination of this specimen revealed metaplastic
ossification to lamellar bone with eosinophilic ossified matrix, lacunar
spaces and haversian vascular canals characteristic of bone
SOURCE
Photo shows a stalagmite, not penile innards.