Multiple Penile Schwannomas

Wayne Young Liu, MD; Chao-Hsiang Chang, MD; Gaun-Chin Tseng, MD

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Case Report

A 41-year-old man presented to our hospital in December 2005 with multifocal penile masses (Figure1). The tumors were located on the penile shaft and had been enlarging gradually for the past 5 years. He had had feelings of compression on erection for about 1 year. Both he and his wife had experienced pain during sexual intercourse, causing them to refrain from sex for the previous 6 months. He had moderate erectile dysfunction; the International Index of Erectile Function (IIEF) for the patient was 14. There was neither history of penile trauma nor any sexual transmitted disease in his medical record.

Multifocal penile tumors located at the dorsum of the penis.

On physical examination, we found 5 painless tumors over the dorsal penile shaft. They were elastic in consistency and had a smooth surface. The largest was approximately 2 cm in diameter and was located near the coronal sulcus at the dorsum of the penis (Figure 1). There was neither penile curvature on erection nor bilateral inguinal lymphadenopathy. Results of blood biochemistry studies and urinalysis were normal.

The largest tumor located near the coronal sulcus was excised in December 2005. We made a circular incision on the coronal sulcus and then peeled back the shaft skin; a well-capsulated tumor located in the Buck's fascia was noted. The tumor was divided carefully in order to preserve the nerve branches. The cut surface of the tumor was homogeneously gray. Hematoxylin-eosin staining of the tumor revealed benign morphology with areas of densely packed spindle cells, termed Antoni A tissue, intermixed with loose myxoid regions, termed Antoni B tissue (Figure 2).

Microscopic pattern of schwannoma. (A) Palisading nuclear regions termed Verocay bodies (Antoni A area). (B) Looser, myxoid regions (Antoni B area; hematoxylin-eosin, 200X).

Postoperatively, there was no numbness or tenderness of the wound on the penile shaft; however, the patient stated at follow-up that he had lost all sexual desire (IIEF= 0). We advised that he be evaluated for erectile dysfunction at our outpatient department, but he refused because he was not concerned.

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