Penile epithelioid sarcoma and the case for a histopathological diagnosis in Peyronie's disease

To devise a set of clinical criteria that would identify which penile abnormality could be malignant and warrant biopsy, between Peyronie's disease (a pathological fibrosis involving the tunica albuginea of the penis) and epithelioid sarcoma (ES) of the penis (a rare malignant condition which can resemble Peyronie's disease in clinical presentation).

The pathology reports and histological slides of men with Peyronie's disease who underwent penile biopsy were reviewed for ES. The medical charts of suspicious cases were then reviewed by a pathologist, unaware of the origin, for consistencies in signs, symptoms and clinical findings. These consistencies were then to be used to develop criteria for biopsy. Thirty-two men underwent penile biopsy from 1992 to 2001.

Because there were no actual cases of ES, a specific set of criteria for ES could not be established. A review of previously published cases was then used for comparison with the present patients.

Many of the previously reported cases included signs and symptoms of urethral narrowing or compression, causing lower urinary tract symptoms. In addition, the penile nodule size was reported to progressively enlarge over time. Because of the high prevalence of Peyronie's disease and low prevalence of ES, biopsy of every penile nodule is not judicious. However, signs and symptoms of urethral obstruction, and a progressively growing and persistently painful nodule should suggest a possible malignancy and warrant biopsy.