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DISORDERS OF THE GENITALIA, PERINEUM, AND ANUS: INTRODUCTION

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  • 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.

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PEARLY PENILE PAPULES ICD-10: N48.89

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  • 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.

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Figure 34-1

Pearly penile papules Pink (skin-colored), 1- to 2-mm papules are seen regularly spaced along the corona of the glans penis. These structures, which are part of the normal anatomy of the glans, are commonly mistaken for condylomata or molluscum contagiosum.

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SEBACEOUS GLAND PROMINENCE ICD-10: Q89.9

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  • 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.

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ANGIOKERATOMA

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  • 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.

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SCLEROSING LYMPHANGITIS OF PENIS ICD-10: N48.29

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  • 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.

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Figure 34-2

Sclerosing lymphangitis: penis A dermal cord on the distal shaft parallel to the corona.

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LYMPHEDEMA OF THE GENITALIA ICD-10: I89.0

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  • 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 ...

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