A rare cause of glans penis masses in childhood: Fibroepithelial polyp.

Fibroepithelial polyps of glans penis are very rarely seen in childhood. A 6-month-old male admitted to our institution with a slowly enlarging glans penis mass on the ventral side of the glans penis. The mass was totally excised, and hystopathological diagnosis was a fibroepithelial polyp. All of the reported cases published previously, except one, are of adult age and all of them have been associated with the history of long-term condom catheter use. The presence of the case in childhood; however, suggests that the pathology might be congenital. This is the second pediatric case presented in the English literature.

INTRODUCTION

Glans penis masses are extremely rare in childhood.[1] These masses are usually fibroma, neurofibroma, hemangioma, epidermal inclusion cysts, and ventral raphe cysts.

Fibroepithelial polyps originating from the urogenital system are more commonly localized in the renal pelvis, proximal urethra, bladder, posterior urethra, vagina, and labia minora. However, fibroepithelial polyps localized on the glans penis are very rare. Fibroepithelial polyps of glans penis are fibrous tumors distinct from lesions occurring in the skin or urinary system.[23] So far, 20 cases of fibroepithelial polyps originating from the penis have been published. 15 of them were localized on the glans, only one of which was in childhood.[4] The presented case is the second report published in the English literature.

CASE REPORT

A 6-month-old male patient with a history of vaginal delivery at 38 weeks with birth weight of 2200 g admitted to the hospital for a glans penis mass [Figure 1]. The parents of the patient stated that they had noticed the mass on the glans penis 4 months before admission to the hospital and that the mass had shown slight enlargement. They didn’t know whether the mass was present at birth because the foreskin was covering the glans. Physical examination revealed an intact foreskin and a conical, clear cystic mass 6 mm × 7 mm in diameter, localized on the ventral side of the glans penis, just adjacent to the urethral meatus and partly deviating but not obstructing the meatus. Other examination findings, laboratory results and abdominal ultrasonography findings were evaluated as normal.

Figure 1

The mass localized on the ventral side of the glans penis

At surgery, cystourethroscopy was performed first to check whether there was an opening of the mass to the urethra, but no communication was observed. The mass was then totally excised, the defect of the glans skin was primarily sutured, and the circumcision was performed.

Histopathological examination showed a polypoid lesion surrounded by keratinized squamous epithelium with loose and well-vascularized stroma. The histological diagnosis was a fibroepithelial polyp [Figure 2]. Postoperative cosmetic appearance of the glans penis was good. No recurrence was observed during 1-year follow-up.

Figure 2

Polypoid lesion with fibrovascular stroma surrounded by keratinized squamous epithelium (H and E, ×200)

DISCUSSION

Fibroepithelial polyp is a benign tumor originating from mesoderm.[2] Fibroepithelial polyps occurring within the urinary tract in childhood usually arise in the proximal ureter, renal pelvis, bladder and urethra. 15 cases of fibroepithelial polyps originating from the glans penis have been published in the literature.[4] Only one of them was in childhood.[5]

Fibroepithelial polyps involving the glans penis in adulthood have been reported to be associated with chronic condom catheter use.[2] Fibroepithelial polyp of glans penis is considered to be a reactive process as a result of local pressure because of chronic condom catheter.[26] A case of glanular fibroepithelial polyp due to genital hanging Kung Fu causing local pressure has been reported in the literature.[6] However, we believe that these theories concerning the etiology of these tumors are not exactly true for children. The current presented case was 6-month-old, and the parents had noticed it when he was 2 months old. This period is too short for a reactive lesion to occur as the result of chronic irritation. Foreskin acts as a protective shield for the glans in infancy and there is physiologic phimosis in almost every boy in early childhood. Therefore, the glans penis has no direct contact with the environment. Moreover, no case of polyp arising from the glans penis has been reported in the circumcised newborns whose glanses are in chronic contact with the diaper. Therefore, we believe that fibroepithelial polyps arising from the glans penis in childhood are congenital rather than the result of local pressure or chronic contact.

The prognosis is usually good, but development of local recurrence after local excision has been reported.[367] Malign degeneration is extremely rare. So far, four cases of fibroepithelial polyps transforming into squamous cell carcinoma have been reported.[48] Only one of them was a giant fibroepithelial polyp [4.5 cm] arising from the glans penis in a 78-year-old male.[4]

The other tumors were localized in the other parts of the body, especially the skin. Fibroma, neurofibroma, hemangioma, epidermal inclusion cysts, and ventral raphe cysts should be considered in the differential diagnosis of masses occurring in the glans penis in childhood. Most of these lesions can be surgically excised, and the diagnosis is confirmed after histopathological examination.

As a result, fibroepithelial polyps of the glans penis are extremely rare, and they might be congenital. Despite benign nature, local recurrence may develop after local excision. Although rare, malign degeneration has been reported. Therefore, these patients should be followed-up for long periods.