HUMAN OS PENIS DEBA E SARMA, M.D. THOMAS G. WEII~BAECttEI~., M.D. From the D e p a r t m e n t of Patholog,~; Veterans Administration Medical Center and Louisiana State University Medical Center, New Orleans, Louisiana
i s--Yi J2? wi,
;)-)ium--a,,
~!~firmation.:,~ . .The . .Er~glish literature fs re~z~,u.,ed; "" and the pa~hoge,zes'is of such a rare lesion is l:'re!Sented..~ emle oss@catum appears to be an acqmred' metaplastic process oecurri~g i~'~ an area of
black m a n presented with )f painful ventral curvature an. He had a past history of :tuiring periodic dilatation. ry of t r a u m a or metabolic :amination revealed a hard ~, about 6 em in length oc~1half of the ventral surface :~ity was noted on the penile ram. t h e results of the routine hend chemical tests were normal. Cysexamination and an intravenous uroid n o t reveal any a b n o r m a l i t y . At he subcutaneous plaque in the ventral the penis extending from the midshaft ,mphysis pubis was easily excised. A :l graft was plaeed over the excised ,stoperative course was uneventful. reported a futl straight ereetion 5. The excised partly bony dense fi:neasured 3.5 × 1.5 × 0.Sere. Mily, cancellous bone was e m b e d d e d in genous tissue (Fig, 1). There was no inflammation. Review of the English Literature T h e probable earliest report of t?enile o,sm-s "~" by M'Clellan in 1827. ~ A fifty-twoan came with u p w a r d incurvation of t:hat on erection would assume "the semicircular bow with concavity up?he septum of the corpora cavernosa v~s oss,.fled. D u r i n g excision "the ossified sub-
APPdI, t990
V O L U M E XXXV. N[ MBb21I ]
stance -was so hard as to grate audibly against the knife, the edge of which was entirely destroyed by the operation." In 1899 C h e t w o o d 2 described a postmortem specimen of ossification of corpora eavernosa obtained from a fifty-five-year-old m a n who was diabetie. The ossification extended from the base of the penis to tile glans, Gerster and M a n d e l b a u m (t913) a exeised a 3.5 × t.7 × 0.3 crn bony tissue from the dorsal side of t h e s e p t u m b e t w e e n t h e c o r p o r a cavernosa from a forty-nine-year-old ,nan, After an elaborate histologic study they concluded that the penile bone had developed in the connective tissue by a process of metaplasia. Vermooten (1933) 4 described a nineteenyear-old man in w h o m a bony mass had dm;'eloped in the glans penis, the site of a gun shot injury three months previousl> The excised mass on microscopic examination revealed bone with bone m a r r o w and cartilage. It appeared to be metaplastic bone formation in the site of traumatic fibrosis. Another case of traumatic ossification of the dorsal penis of a f o r t y - n i n e - y e a > o l d was described by S u b r a m a n i a m (1.952)? The patient was hit on the dorsum of the penis by a tennis ball twenty years previously. Eglitis (1953) ~ described an unusual case of penile ossification occurring in a twenty-eightyear-old man, On microscopic examination of sections from a grossly normal pe~ds at autops> there were numerous bony plates (5-8 m m long
349
F:mt m~ i. Cancellous bone surrounded by fibrous ~%'sue. (Hematoxylb~ and eosin, origh~al magniJication × ~qO.) and 0.5-2 m m wide) in the subcutaneous ti~ue, particularly in the dorsal and lateral parts of the penis. Transition from fibrous connective tissue to bone was noted. There were no clues regarding the etiology of the ossification. Elliot and Fischman (1962)7 excised a 2-inchh m g bone from the tuniea albuginea of the dorsal corpus spongiosum of a sLxty-eight-year-old man. Although the .man h a d suffered w i t h gout, bone forrnation was t h o u g h t to be unrelated. The first ease of congenital os penis in a hum a n was exeised by C h a m p i o n and Wegrzyn (1964) s in a five-year-old boy. From birth the patient h a d a fixed penile curvature due to a bone in the right paraurethral region r u n n i n g from the isehium up to 1 em from the eorona. He also had a cleft serotum. In 196(i a case of penile ossification associated with squamous eell earcinorna of the penis oecurring in a sixty-five-year-old m a n was reported by Morgan. 9 Smith (1966) ~° reported 3 eases of ossification in the excised plaques from 26 patients with Peyronie disease. Five single cases ~-~5 of penile ossification reported since 1966 appear to be associated with Peyronie disease. Comment Many animals possess a penile bone called os penis, os priapi or baculum. The whale's os penis may measure as long as 200 cm in length and 40 cm in circumference. D u r i n g the process of evolution the os penis has progressively diminished in size until in some apes, it is an insignificant 10-20 m m structure. The nearest akin to man, the chimpanzee has no os penis, but only a small fragment of bone in the glans. The os penis in animals such as bear and wolf may serve to produce a rapidly erectile state for copulation. In the dog it serves as a channel for ~he urethra. The animals posssessing os penis have poorly developed erectile tissue; the penile
380
bone that is Wpieally situated in the aid to copulation. The erectile tissu penis is well developed so that the ra tion oecurring usually in the penile to a penile eurvature on erection copulation. The osseous tissue found m a n penis does not appear to be a pl vestige because t h e bones that are roans are larger than the os penises The os penis in h u m a n s appears quired during the adult life. The si: of a congenital os penis was assoc other anomalies such as cleft serotm T h e ossification in the h u m a n pe~ to be a metaplastie process, a,~ The probably takes place in a fertile sot] of fibroblastie tissue. Various eond as trauma, 4,~ neoplasm, "~'venereal dfi most commonly Peyronie disease, ~° i metaplastie ossification. Metabol such as gout" and diabetes melIitus been described in some cases of per] tion. In our patient the ossification: consistent: with a metaplastie proee: trat Peyronie plaque. 1601 Perdi, New Orleans, Louisia!
(DK References 1, M'Clellan G: Ossification of eavernosa of the penis, Philadelphia
(18~7) 2. Chetwond Ctt: Pn~entation of sified plaque of corpora eavernosa,
231 (1899). 3. Gerster aG, and Mandelbaum FS: On ~ e formation i bone in the human penis, Ann Surg 57:896 (19131 4. V{~rmootenV: Metaplasia in the penis: the presen~ d Ni~.i bone marrow and eartilage in ~he glans, N Engi J Mec~ (1%3). 5. Subramaniam TK: Bone in the penis, J Indian Med A'~s 21:437 (19,5"2). 6. Eglitis JA: Occurrence of bone tissue in the human Urnl 70:749 (1953). 7. Ellint JR and Fisehmar JL" Os l:~nis~ J Urol 8& 8. Champion RH, and g2~grzyn J: Co~geMtal os p 91:663 (t964). 9, Mnrgan C: Bone formatinn in the penis associate
Urolng,e 20:428 (t982). 13. Mnhar N: Os Penis: the plastie indm metaplasia of fibrous connective ti,~sue into sue, bit I Dermatnt 22:235 (I983). 14. Villani U, Leoni S, and Casnlari E:
4°,o (198,~).
15. ~ ' t ~ s p c s E, Bredael JJ, Cnuvreur 5 Penile ossification in man, Eur UroI t h 7~ ,,.......... / ,
UROLOGY
APEtI, 1 9 9 0
VOI,L'ME XXXV,
i s--Yi J2? wi,
;)-)ium--a,,
~!~firmation.:,~ . .The . .Er~glish literature fs re~z~,u.,ed; "" and the pa~hoge,zes'is of such a rare lesion is l:'re!Sented..~ emle oss@catum appears to be an acqmred' metaplastic process oecurri~g i~'~ an area of
black m a n presented with )f painful ventral curvature an. He had a past history of :tuiring periodic dilatation. ry of t r a u m a or metabolic :amination revealed a hard ~, about 6 em in length oc~1half of the ventral surface :~ity was noted on the penile ram. t h e results of the routine hend chemical tests were normal. Cysexamination and an intravenous uroid n o t reveal any a b n o r m a l i t y . At he subcutaneous plaque in the ventral the penis extending from the midshaft ,mphysis pubis was easily excised. A :l graft was plaeed over the excised ,stoperative course was uneventful. reported a futl straight ereetion 5. The excised partly bony dense fi:neasured 3.5 × 1.5 × 0.Sere. Mily, cancellous bone was e m b e d d e d in genous tissue (Fig, 1). There was no inflammation. Review of the English Literature T h e probable earliest report of t?enile o,sm-s "~" by M'Clellan in 1827. ~ A fifty-twoan came with u p w a r d incurvation of t:hat on erection would assume "the semicircular bow with concavity up?he septum of the corpora cavernosa v~s oss,.fled. D u r i n g excision "the ossified sub-
APPdI, t990
V O L U M E XXXV. N[ MBb21I ]
stance -was so hard as to grate audibly against the knife, the edge of which was entirely destroyed by the operation." In 1899 C h e t w o o d 2 described a postmortem specimen of ossification of corpora eavernosa obtained from a fifty-five-year-old m a n who was diabetie. The ossification extended from the base of the penis to tile glans, Gerster and M a n d e l b a u m (t913) a exeised a 3.5 × t.7 × 0.3 crn bony tissue from the dorsal side of t h e s e p t u m b e t w e e n t h e c o r p o r a cavernosa from a forty-nine-year-old ,nan, After an elaborate histologic study they concluded that the penile bone had developed in the connective tissue by a process of metaplasia. Vermooten (1933) 4 described a nineteenyear-old man in w h o m a bony mass had dm;'eloped in the glans penis, the site of a gun shot injury three months previousl> The excised mass on microscopic examination revealed bone with bone m a r r o w and cartilage. It appeared to be metaplastic bone formation in the site of traumatic fibrosis. Another case of traumatic ossification of the dorsal penis of a f o r t y - n i n e - y e a > o l d was described by S u b r a m a n i a m (1.952)? The patient was hit on the dorsum of the penis by a tennis ball twenty years previously. Eglitis (1953) ~ described an unusual case of penile ossification occurring in a twenty-eightyear-old man, On microscopic examination of sections from a grossly normal pe~ds at autops> there were numerous bony plates (5-8 m m long
349
F:mt m~ i. Cancellous bone surrounded by fibrous ~%'sue. (Hematoxylb~ and eosin, origh~al magniJication × ~qO.) and 0.5-2 m m wide) in the subcutaneous ti~ue, particularly in the dorsal and lateral parts of the penis. Transition from fibrous connective tissue to bone was noted. There were no clues regarding the etiology of the ossification. Elliot and Fischman (1962)7 excised a 2-inchh m g bone from the tuniea albuginea of the dorsal corpus spongiosum of a sLxty-eight-year-old man. Although the .man h a d suffered w i t h gout, bone forrnation was t h o u g h t to be unrelated. The first ease of congenital os penis in a hum a n was exeised by C h a m p i o n and Wegrzyn (1964) s in a five-year-old boy. From birth the patient h a d a fixed penile curvature due to a bone in the right paraurethral region r u n n i n g from the isehium up to 1 em from the eorona. He also had a cleft serotum. In 196(i a case of penile ossification associated with squamous eell earcinorna of the penis oecurring in a sixty-five-year-old m a n was reported by Morgan. 9 Smith (1966) ~° reported 3 eases of ossification in the excised plaques from 26 patients with Peyronie disease. Five single cases ~-~5 of penile ossification reported since 1966 appear to be associated with Peyronie disease. Comment Many animals possess a penile bone called os penis, os priapi or baculum. The whale's os penis may measure as long as 200 cm in length and 40 cm in circumference. D u r i n g the process of evolution the os penis has progressively diminished in size until in some apes, it is an insignificant 10-20 m m structure. The nearest akin to man, the chimpanzee has no os penis, but only a small fragment of bone in the glans. The os penis in animals such as bear and wolf may serve to produce a rapidly erectile state for copulation. In the dog it serves as a channel for ~he urethra. The animals posssessing os penis have poorly developed erectile tissue; the penile
380
bone that is Wpieally situated in the aid to copulation. The erectile tissu penis is well developed so that the ra tion oecurring usually in the penile to a penile eurvature on erection copulation. The osseous tissue found m a n penis does not appear to be a pl vestige because t h e bones that are roans are larger than the os penises The os penis in h u m a n s appears quired during the adult life. The si: of a congenital os penis was assoc other anomalies such as cleft serotm T h e ossification in the h u m a n pe~ to be a metaplastie process, a,~ The probably takes place in a fertile sot] of fibroblastie tissue. Various eond as trauma, 4,~ neoplasm, "~'venereal dfi most commonly Peyronie disease, ~° i metaplastie ossification. Metabol such as gout" and diabetes melIitus been described in some cases of per] tion. In our patient the ossification: consistent: with a metaplastie proee: trat Peyronie plaque. 1601 Perdi, New Orleans, Louisia!
(DK References 1, M'Clellan G: Ossification of eavernosa of the penis, Philadelphia
(18~7) 2. Chetwond Ctt: Pn~entation of sified plaque of corpora eavernosa,
231 (1899). 3. Gerster aG, and Mandelbaum FS: On ~ e formation i bone in the human penis, Ann Surg 57:896 (19131 4. V{~rmootenV: Metaplasia in the penis: the presen~ d Ni~.i bone marrow and eartilage in ~he glans, N Engi J Mec~ (1%3). 5. Subramaniam TK: Bone in the penis, J Indian Med A'~s 21:437 (19,5"2). 6. Eglitis JA: Occurrence of bone tissue in the human Urnl 70:749 (1953). 7. Ellint JR and Fisehmar JL" Os l:~nis~ J Urol 8& 8. Champion RH, and g2~grzyn J: Co~geMtal os p 91:663 (t964). 9, Mnrgan C: Bone formatinn in the penis associate
Urolng,e 20:428 (t982). 13. Mnhar N: Os Penis: the plastie indm metaplasia of fibrous connective ti,~sue into sue, bit I Dermatnt 22:235 (I983). 14. Villani U, Leoni S, and Casnlari E:
4°,o (198,~).
15. ~ ' t ~ s p c s E, Bredael JJ, Cnuvreur 5 Penile ossification in man, Eur UroI t h 7~ ,,.......... / ,
UROLOGY
APEtI, 1 9 9 0
VOI,L'ME XXXV,
