Idiopathic calcinosis cutis of the penis

Abstract

Background: Calcinosis cutis-the deposition of insoluble calcium salts in the skin and the soft tissue-occurs in the following five settings: calciphylaxis, dystrophic, iatrogenic, idiopathic, and metastatic. Idiopathic calcinosis cutis of the penis is rare.

Purpose: This paper describes a man with idiopathic calcinosis cutis of the penis, summarizes the clinical features of previously reported men with this condition, and also reviews dystrophic, iatrogenic, and metastatic penile calcinosis.

Methods: A 27-year-old Pakistan man presented with concurrent, asymptomatic, individual nodules on the right mid-ventral penile shaft and left side of scrotum and two additional papules on the right side of the scrotum. Evaluation and treatment included the excision of all lesions. Reports of patients with penile calcinosis were identified using a medical search engine (PubMed Central) and referenced citations from the published papers on this subject.

Results: Microscopic examination of the patient's nodules showed idiopathic and dystrophic calcinosis cutis of the penis and scrotum, respectively; the scrotal papules were fibroepithelial polyps. Including this individual, idiopathic calcinosis cutis of the penis has only been reported in 11 men. It presents as either an asymptomatic nodule (5 patients) or multiple lesions (6 patients) of less than one-year duration, on either the penile shaft (distal in 4 patients, mid in 2 patients, both in 1 patient, and site unspecified in 1 patient) or the prepuce (3 patients) of uncircumcised men less than 30 years of age. Concurrent scrotal calcification was noted in two patients. Dermal deposits of calcium are found in the dermis-often with surrounding histiocytes and multinucleated giant cells; concurrent features of dystrophic penile shaft calcification, such as calcium within syringomas or transepidermal elimination of calcium through eccrine sweat ducts, was only noted in two men. The nodules do not recur following excision.

Conclusion: Idiopathic calcinosis cutis of the penis is extraordinary and has only been reported in 11 men. It presents as an asymptomatic nodule or nodules on mid- to distal penile shaft or foreskin. Concurrent scrotal calcinosis cutis was noted in two men. Microscopic examination shows calcium deposits in the dermis, usually with associated histiocytes and multinucleated giant cells; concurrent changes of dystrophic calcification were also present in two men. Excision of the penile nodules not only provides the diagnosis, but also successfully resolves the condition without recurrence.

Figures 1A and 1B

Distant and closer views of idiopathic calcinosis cutis of the penis presenting as an asymptomatic smooth firm reddish-brown to flesh-colored nodule on the right side of the mid ventral penile shaft in a 27-year-old man.

Figures 1A and 1B

Distant and closer views of idiopathic calcinosis cutis of the penis presenting as an asymptomatic smooth firm reddish-brown to flesh-colored nodule on the right side of the mid ventral penile shaft in a 27-year-old man.

Figures 2A and 2B

Distant and closer views of concurrently present scrotal calcinosis in the same 27-year-old man appearing as an asymptomatic smooth hard reddish-brown to flesh-colored nodule on the left side of the scrotum.

Figures 2A and 2B

Distant and closer views of concurrently present scrotal calcinosis in the same 27-year-old man appearing as an asymptomatic smooth hard reddish-brown to flesh-colored nodule on the left side of the scrotum.

Figures 3A and 3B

Larger and smaller, biopsy-confirmed, fibroepithelial polys that were also concurrently present on the right side of the 27-year-old man's scrotum.

Figures 3A and 3B

Larger and smaller, biopsy-confirmed, fibroepithelial polys that were also concurrently present on the right side of the 27-year-old man's scrotum.

Figures 4A and 4B

Microscopic examination—lower (left) and higher (right) magnification—of the penile nodule shows basophilic-staining deposits of calcium crystal in the dermis without any surrounding epithelial lining or inflammation (hematoxylin and eosin: X4; X20).

Figures 4A and 4B

Microscopic examination—lower (left) and higher (right) magnification—of the penile nodule shows basophilic-staining deposits of calcium crystal in the dermis without any surrounding epithelial lining or inflammation (hematoxylin and eosin: X4; X20).

Figures 5A and 5B

Microscopic examination—lower (left) and higher (right) magnification—of scrotal nodule shows basophilic-staining calcified mass surrounded by an epithelial lining in the dermis; eccrine structures, composed of similar appearing cells as the epithelial lining surrounding the amorphous mass of calcium, are present in the adjacent dermis (hematoxylin and eosin: X4; X10).

Figures 5A and 5B

Microscopic examination—lower (left) and higher (right) magnification—of scrotal nodule shows basophilic-staining calcified mass surrounded by an epithelial lining in the dermis; eccrine structures, composed of similar appearing cells as the epithelial lining surrounding the amorphous mass of calcium, are present in the adjacent dermis (hematoxylin and eosin: X4; X10).