Section 34: Disorders of the Genitalia, Perineum, and Anus

INTRODUCTION

• Primary neoplasms that arise in anogenital areas are most commonly associated with chronic human papillomavirus (HPV) infection.

• Sexually transmitted as well as other infections also occur commonly.

• Often normal structures, newly observed, give rise to great concerns about sexually transmitted infections such as anogenital warts and molluscum contagiosum.

PEARLY PENILE PAPULES ICD-10: N48.89

• Normal anatomic structures. Incidence: Up to 19%.

• Symptoms: Asymptomatic; may arouse some anxiety when first noted.

• Clinical findings: Skin-colored 1- to 2-mm, discrete, domed papules evenly distributed circumferentially around the corona (Fig. 34-1).

• Differential diagnosis: Condylomata acuminatum, molluscum contagiosum.

• Histology: Angiofibromas.

• Management: Reassurance: Normal anatomic structures. Laser therapy has been reported.

SEBACEOUS GLAND PROMINENCE ICD-10: Q89.9

• Normal sebaceous glands. Analogous to sebaceous gland on mucosa of mouth.

• Locations: Penis and vulva.

• Manifestation: 2-mm dermal papule; cream colored. May be arranged in rows.

• Synonyms: Tyson glands, sebaceous hyperplasia, “ectopic” sebaceous glands, and Fordyce condition.

ANGIOKERATOMA

• Ectatic thin-walled blood vessels in the superficial dermis with overlying epidermal hyperplasia (See also Section 9).

• Increasingly common with aging.

• Multiple purple, smooth, 2- to 5-mm papules. Bleed with trauma (see Section 9, Fig. 9-26).

• Location: Scrotum, glans penis, and penile shaft. Labia and vulva.

• Differentiate from angiokeratomas of Fabry disease (usually pinhead size, found on bathing trunk area and upper thighs), and Kaposi sarcoma.

• Management: Reassurance and electrosurgery.

SCLEROSING LYMPHANGITIS OF PENIS ICD-10: N48.29

• Etiology: Trauma associated with vigorous sexual activity.

• Pathogenesis: Lymphatic stasis may result in thrombosed lymphatic vessels.

• Clinical findings: Painless, firm, at times nodular, translucent serpiginous cord appears suddenly, usually parallel to corona; not attached to overlying epidermis (Fig. 34-2).

• Course: Resolves spontaneously in weeks to months.

• Synonyms: Nonvenereal sclerosing lymphangitis, penile venereal edema, and Mondor phlebitis.

LYMPHEDEMA OF THE GENITALIA ICD-10: I89.0

• Acute idiopathic scrotal edema. Occurs in young boys. Resolves spontaneously in 1 to 4 days. Differentiate from acute scrotum. Also reported in adults with dengue hemorrhagic fever, Henoch–Schönlein purpura.

• Lymphogranuloma venereum (see Section 30). Occurs in chronic undiagnosed infection. Both sexes. Referred to as esthiomene: elephantiasis resulting from lymphatic obstruction.

• Chronic recurrent bacterial infection may be causative (...