A story with images: A Soft Tissue Disease. What is the diagnosis?

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1) This unhappy middle aged couple decided to file for divorce due to sexual incompatibility. Lady was unhappy with her husband's weird behaviour.

2) The smart advocate listened to all their problems and realized it was a medical case. He advised the husband to get a medical check up.

Experience of the couple with 3 pathologists:

(Dr A) General Pathologist

Dr A listened to the history, had a chat with the clinician,did some basic immunostains and promptly gave the report.

He advised the couple to take a second opinion from a specialist in Genitourinary Pathology based on the macroscopic location of the lesion. (Penile lesion)

(Dr B) Specialist in Genitourinary Pathology

Dr B - Examined the slides and refused to give any opinion. He referred the case to Dr C.

Reason: Macroscopically, it is a penile lesion.

According to microscopic features it is a soft tissue lesion, hence the case should be reported by a specialist in soft tissue pathology.

(Dr C) Specialist in Soft Tissue Pathology

Dr C was happy to a give his opinion as a specialist. (Great minds think alike).

He was unhappy that no tissue was available for molecular and cytogenetic analysis.

He asked Dr A for the paraffin block and did further immunohistochemical stains.

Final diagnosis was same as the diagnosis made by Dr A.

Can you think of a diagnosis based on one Hematoxylin/Eosin stained image and clinical history?

Answer:

Penile Fibromatosis (Peyronie's Disease, plastic induration of the penis, fibrous sclerosis of penis).

This lesion is usually seen in male adults above 40 years of age.

It is characterized by circumscribed fibrous tissue between corpora cavernosa and the tunica albuginea.

Firm nodules and plaques are present on the dorsal surface of the penile shaft.

Clinically, the fibrous tissue plaques cause penile curvature and severe pain during erection and erectile dysfunction.

They are still married and lived happily ever after.

The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding.

Peyronie's disease: review and recent advances.

Peyronie's disease plaque calcification--prevalence, time to identification, and development of a new grading classification.

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