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Case Report |
From the Departments of * Pathology and
Andrology, Fundación Puigvert,
Barcelona, Spain.
| Correspondence to: Rosana Rodríguez-Villalba (e-mail: rrodvillalba{at}mixmail.com). |
| Received for publication February 12, 2003; accepted for publication May 9, 2003. |
To our knowledge, only 19 cases have been reported in the literature. We report 2 cases that presented to our hospital.
Case 1
A 44-year-old man presented to our hospital complaining of perineal pain
during ejaculation and a small nodule in the glans sulcus, which was
particularly distressing to him during intercourse
(Figure 1).
|
On physical examination, the patient presented with a painless nodule at the right and posterior area of the glans sulcus that was less than 5 mm in diameter, with no other lesions on the skin. Urine and semen cultures were negative. The patient underwent a surgical excision of the tumor, and the biopsy showed a benign Schwannoma.
Case 2
A 53-year-old man was referred to our hospital with a diagnosis of Peyronie
disease and erectile dysfunction of 4 years' duration
(Figure 2).
|
On physical examination, we found a painless nodule at the base of the penis associated with the left corpus cavernosum. The patient related that it interfered with intercourse. On palpation, no plaques were detected on the penis. This patient underwent diagnostic intracavernosal injection with 20 µg of alprostadil, which resulted in his having a complete erection. The photographs that were taken did not show a significant incurvation. He also had asymptomatic subcutaneous nodules on the thorax and left arm that had not undergone biopsy. The patient had no "café au lait" lesions on his skin and no family background of von Recklinghausen disease. He underwent a surgical excision of the lesion, which yielded a yellow tumor with a regular surface that measured 1.6 by 1 by 0.7 cm. Pathology reported a benign Schwannoma.
Discussion
Schwannomas can present on a patient as a solitary tumor or as part of a
systemic disease that may involve the nervous system. Neither of the patients
of our study showed any other feature of systemic disease.
Schwannomas may be benign or malignant tumors; malignancy is associated with von Recklinghausen disease. In spite of the abundant sensitive innervation of the penis and perineal skin, schwannomas of the penis are very rarely reported (Marsidi and Winter, 1980; Chan et al, 1990; Mayersak et al, 1995; Suzuki et al, 1998; Sato et al, 2001).
The pathological hallmark of schwannoma (also named neurilemoma) is the pattern of alternating Antoni A and B areas. These Antoni areas are generally present in varying ratios. Antoni A areas are composed of compact spindle cells with twisted nuclei, inconspicuous nucleoli, and indistinct cytoplasmic borders that are arranged in short and interwoven bundles. Antoni B areas are far less orderly and less cellular, with a loosely textured matrix. S100 protein (expressed in the supporting cells of the nervous system) can be demonstrated in these tumors, particularly in the Antoni A areas, which were predominant in the patients of this study.
Despite the rare presentation of schwannomas, we believe it important to include this pathology as a differential diagnosis between these lesions (especially those located beneath the Buck fascia) and Peyronie disease plaques.
References
Chan WP, Chiang SS, Huang AH, Lin CN. Penile frenulum neurilemoma: a rare and unusual genitourinary tract tumour. J Urol. 1990; 144:136-137.[Medline]
Marsidi PJ, Winter CC. Schwannoma of the penis. Urology. 1980;16:303-304.[Medline]
Mayersak JS, Viviano CJ, Barbiarz JW. Schwannoma of the penis. J Urol. 1995;153:1931-1932.[Medline]
Sato D, Kase T, Tajima M, Sawamura Y, Matsushima M, Wakayama M, Kuwajima A. Penile schwannoma. Int J Urol. 2001; 8:87-89.[Medline]
Suzuki Y, Ishigooka M, Tomaru M, Abe Y, Kubota Y, Nakada T. Schwannoma of the penis: report of a case and review of the literature. Int Urol Nephrol. 1998; 30:197-202.[Medline]
This article has been cited by other articles:
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  E. P. Lin, J. Marshall, S. Bhatt, R. Simon, R. Davis, and V. S. Dogra Penile schwannoma: sonographic features. J. Ultrasound Med., November 1, 2006; 25(11): 1447 - 1450. [Full Text] [PDF]
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