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.
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
Photo shows a stalagmite, not penile innards.