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 Table of Contents  
SHORT COMMUNICATION
Year : 2016  |  Volume : 5  |  Issue : 3  |  Page : 341-342

Tuberculosis of the glans penis mimicking as carcinoma


1 Department of Urology, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Surgery, Radha Gobinda Kar Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication13-Feb-2017

Correspondence Address:
Dawood Khan
Room 9A, Kitchen Block Hostel, Radha Gobinda Kar Medical College Campus, Kolkata 700004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijmyco.2016.04.003

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  Abstract 


Penile tuberculosis (TB) is an uncommon variety of genitourinary TB. It is either primary (via local spread) or secondary (spread of infection from other organs). We encountered a case of rapidly growing penile ulceration, resembling carcinoma. Biopsy revealed the classic picture of TB, which responded well to antitubercular treatment.

Keywords: Case report, Penile cancer, Penile lupus vulgaris, Penile tuberculosis


How to cite this article:
Khan D, Choudhary A, Dutta A, Khan I. Tuberculosis of the glans penis mimicking as carcinoma. Int J Mycobacteriol 2016;5:341-2

How to cite this URL:
Khan D, Choudhary A, Dutta A, Khan I. Tuberculosis of the glans penis mimicking as carcinoma. Int J Mycobacteriol [serial online] 2016 [cited 2019 Oct 17];5:341-2. Available from: http://www.ijmyco.org/text.asp?2016/5/3/341/200076




  Case report Top


A 65-year-old man from a rural area in Kolkata presented to us with complaints of ulceration over the glans penis for 3 months. It initially began as a small patchy lesion, which later increased in size and ulcerated. There was some associated discharge and pain. He neither had a history of significant lower urinary tract symptoms nor hematuria. The patient was also not a known diabetic or hypertensive and had no past exposure to tuberculosis (TB).

The patient was moderately built and nourished. On examination, a part of the glans penis was destroyed and a cauliflower-shaped irregular ulcer partially covered with white slough was present over the front and ventral aspect of the glans approaching the distal shaft of the penis ([Figure 1]). The base of ulcer was pink and edges were rolled out. The urethral opening was intact. Slight tenderness could be elicited over the ulcer. Multiple discrete mobile nontender lymph nodes were found over the bilateral inguinal region. Cervical and axillary nodes were not palpable. Bilateral renal angles were nontender and external genitalia examination was unremarkable. Systemic examination was normal.
Figure 1: Ulcer occupying the ventral half of the glans with irregular margins and covered with slough and scanty discharge.

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A provisional diagnosis of carcinoma of the penis was made and wedge biopsy was taken. Histopathology revealed lymphoplasmacytic infiltration of subepithelial fibrocollagenous tissue along with the presence of epithelioid granuloma with caseation, suggesting a mycobacterial infection ([Figure 2]). Mantoux test was 17 mm. Fine-needle aspiration cytology from inguinal lymph nodes showed reactive hyperplasia. Abdominal ultrasound, chest X-ray, and sputum microscopy results were normal. Polymerase chain reaction (PCR) from tissue specimen confirmed the presence of TB. Enzyme-linked immunosorbent assay for human immunodeficiency virus (HIV) was negative. His female partner was not available for evaluation.
Figure 2: Histopathology revealing epithelioid granuloma with central area of necrosis surrounded by lymphocytes.

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The patient was put on antitubercular therapy under Category 1, with isoniazid–rifampin–pyrazinamide–ethambutol (HRZE) for 2 months followed by isoniazid–rifampin (HR) for the next 4 months. After 4 months of treatment, a significant healing was noted in the ulcer and after 6 months it healed completely.


  Discussion Top


Genitourinary TB (GUTB) is the most common form of extrapulmonary TB, but penile affection is one of the least common GUTB cases (<1%) [1]. In a more common secondary form, it occurs due to systemic spread of infection from pulmonary or extrapulmonary sources. In the primary form, local spread of bacilli from clothing, ejaculation, endometrial secretions, circumcision, and intravesical bacillus Calmette–Guérin has been reported [2]. In our case, no primary affection of TB could be found elsewhere in the body and the patients female partner could not be evaluated. The exact incidence of penile TB is not known. Pathogenesis appears to be the heightened sensitivity to the tubercular antigen in an immunocompetent state, which on exposure leads to the characteristic granulomatous inflammatory reaction [3]. Patients usually present with papule or nodule over the glans, which gradually ulcerates. Disease often remains in the subcutaneous tissue, although occasionally reports have indicated urethral and cavernosal involvement [4].

Evaluation of penile ulceration warrants ruling out malignancy, granulomatous syphilitic ulcer, herpetic ulcer, HIV, apart from TB [5]. On microscopy, discharge from an ulcer may show bacilli on Ziehl–Neelsen staining, and so a culture test will aid in diagnosis. However, isolation is not possible in every case. Biopsy from a penile lesion usually establishes the diagnosis and reveals caseating granuloma with abundant lymphocytes, as was found in our case [6]. PCR is another method of diagnosis and is both reliable and accurate. A search for the primary lesion should be done with chest X-ray, ultrasound abdomen, and scrotum. Patient partners must be evaluated for TB [7]. Treatment includes the four-drug therapy, HRZE, under Category 1 for 6 months. Although resistance is rare, sensitivity test to the drugs is worthwhile. Lesions respond well, with healing seen by 4–6 months [8]. No recurrent form so far has been reported.

In conclusion, Penile TB is a rare form of GUTB. Ulceration may mimic malignancy and biopsy often establishes the diagnosis. Conservative treatment with an antitubercular regime is the mainstay to resolve the disease.


  Conflicts of interest Top


None declared.



 
  References Top

1.
E. Nimisha, G. Gupta, Penile lupus vulgaris: a rare presentation of primary cutaneous tuberculosis, Int. J. STD AIDS 25 (2014) 969–970.  Back to cited text no. 1
    
2.
M.A. Amir-Zargar, M. Yavangi, M. Ja'fari, Primary tuberculosisof glans penis: a case report, Urol. J. 1 (2004) 278–279.  Back to cited text no. 2
    
3.
S.S. Aradhya, S. Shankar, Lupus vulgaris of the glans penis: arare presentation, Indian Dermatol. Online J. 5 (2014) 309–311.  Back to cited text no. 3
    
4.
C. Savu, C. Surcel, C. Mirvald, Atypical primary tuberculosismimicking an advanced penile cancer. Can we rely onpreoperative assessment?, Rom J. Morphol. Embryol. 53 (2012) 1103–1106.  Back to cited text no. 4
    
5.
A.K. Venyo, Tuberculosis of the penis: a review of theliterature, Scientifica (Cairo) 2015 (2015) 601624.  Back to cited text no. 5
    
6.
B.J. Angus, M. Yates, C. Conlon, Cutaneous tuberculosis of thepenis and sexual transmission of tuberculosis confirmed bymolecular typing, Clin. Infect. Dis. 33 (2001) E132–E134.  Back to cited text no. 6
    
7.
M. Rotaru, S. Tăban, M. Ţă roi, An immunocompetent youngpatient with tuberculosis of the penis: a challenging case, Rom. J. Morphol. Embryol. 56 (2015) 569–574.  Back to cited text no. 7
    
8.
S. Deb, S. Mukherjee, J. Seth, Nodulo-ulcerative tuberculosis ofthe glans penis – a case report and a discussion onnomenclature of genital tuberculosis, Indian J. Dermatol. 60(2015) 506–508.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Urogenital tuberculosis epidemiology, pathogenesis and clinical features
Asif Muneer,Bruce Macrae,Sriram Krishnamoorthy,Alimuddin Zumla
Nature Reviews Urology. 2019;
[Pubmed] | [DOI]



 

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