Epidermoid cyst of the glans penis

Shankar Prasad Hazra, Rajkumar Singha Mahapatra, Debasis Chakraborty, Dilip Kumar Pal

 Departments of Urology and Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Correspondence Address:
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, 244, AJC Bose Road, Kolkata - 700 020, West Bengal
India

Sir,

Epidermoid cysts are the commonest type of cutaneous cysts. They can occur anywhere on the external surface of the body as a single or multiple firm nodule. On the scrotum, they are often multiple and can be calcified. They rarely occur in the glans penis. Here, we report such a case of epidermoid cyst of the glans penis.

A 45-year-old Hindu male patient presented to our outpatient department with a small, painless swelling in his glans penis for the last eight years. On examination, it was found that the swelling was 1.5 × 1 cm in size, smooth, rounded and non-tender. It was situated just outside the external urinary meatus and no obvious punctum was found [Figure - 1]. The external urethral meatus was normal in shape and size. He had a previous episode of spontaneous rupture of the cyst with extrusion of cheesy material after which the swelling disappeared. Thereafter, it reappeared slowly at the same site and attained the present size over two years. He was normoglycaemic, with normal renal and hematological parameters.

Figure 1: Smooth, rounded cyst on the glans penis

Under general anesthesia, the cyst was excised completely and the patient was catheterized. Sectioning of the cyst after removal caused extrusion of white pultaceous material. Histopathological examination confirmed the diagnosis of an epidermoid cyst lined by stratified squamous epithelium containing laminated keratin debris [Figure - 2] and [Figure - 3]. The lesion did not recur during the follow-up period of one year.

Figure 2: Epidermoid cyst lined by squamous epithelium (H and E, ×10)

Figure 3: Keratinous cyst content and the cyst wall (H and E, ×40)

Epidermoid cyst is very uncommon in the glans penis. ^[1],[2] The first case was reported by Khanna in 1991. ^[1] Two further reports of epidermoid cyst of the glans penis in children by Papali et al. in 2008 were discovered after a MEDLINE search. ^[2] Though rare, Shah et al. (1972) reported a sebaceous cyst in the penile shaft. ^[3] Suwa et al. (2000) and Singh et al. (2011) reported epidermoid cysts in the median raphe of the penis. ^[4],[5] Cysts at this site have been ascribed to previous circumcision or trauma to the penis. ^[5] The criteria proposed for diagnosis of epidermoid cysts of the glans penis are the following: It should be surrounded by penile tissue, filled with keratin material only, with an inner lining of stratified squamous epithelium, without any dermal appendages. ^[1] The differential diagnosis includes dermoid cyst or teratoma which can be easily differentiated by histopathological examination. The indications for treatment of this cyst are secondary infection, pain on intercourse, obstruction of urinary flow or cosmetic concerns. ^[4] The best treatment option is complete excision, but the surgeon should carefully excise the entire cyst to avoid recurrence. Though malignant changes are reported in epidermoid cyst at other sites, there are no reports of malignant changes in penile or glandular epidermoid cyst till date. ^[4],[5]

1.	Khanna S. Epidermoid cyst of the glans penis. Eur Urol 1991:19:176-7. [Google Scholar]
2.	Papali AC, Alpert SA, Edmondson JD, Maizels M, Yerkes E, Hagerty J, et al. A review of pediatric glans malformations: A handy clinical reference. J Urol 2008;180(Suppl 4):1737-42. [Google Scholar]
3.	Shah SS, Varea EG, Farsaii A, Fernandez R, Richardson C, Schutte H. Giant epidermoid cyst of penis. Urology 1979;14:389-91. [Google Scholar]
4.	Suwa M, Takeda M, Bilim V, Takahashi K. Epidermoid cyst of the penis: A case report and review of the literature. Int J Urol 2000;7:431-3. [Google Scholar]
5.	Singh S, Kaur T. Epidermoid cyst of penis. Indian J Dermatol Venereol Leprol 2011:77:627. [Google Scholar]