Pediatric leiomyoma of the glans

Abstract

The leiomyoma is a benign tumor of smooth muscle. 

Key Words: Leiomyoma, Glans, Glans disease, Glans penis

Introduction

Leiomyoma is a ubiquitous, benign mesenchymal tumor originating from smooth muscle cells. Typically, it affects a single organ or multiple organs. Capsules of kidney, genitourinary system seems to be the most frequent location. Localization at the level of the glans, especially in children, is very rare, with only three cases reported in literature till June 2021. The study describes the case of an 11year-old boy with a painless, non-bleeding or itchy tumor of the glans.

Case Report

In clinical examination of the boy, the tumor appeared at the level of the right dorso-lateral surface of the glans, reaching the balano-preputial sulcus. Firm, painless, yellowish white color oval shaped tumor with a diameter of about 12 mm, hard consistency, clear margins and slightly raised with respect to the mucous surface.

Treatment

Submucosal isolation was done by blunt dissection with micro-bipolar, of the neoformation, allowing its total “enbloc” removal. The later restoration of the glans consisted of the juxta position of the glandular epithelium with separate stitches in 6/0 polydioxanone absorbable monofilament (PDSTM Ethicon Suture). The histological study showed spindle cells with an eosinophilic cytoplasm while the immunohistochemical studies confirmed cells stained strongly positive for actin present in smooth muscle. After surgery, the clinical follow-up of more than 5 years reveals the absence of recurrence and discomfort for the patient and a good aesthetic appearance of the glans.

Discussion

In all cases of glans localization reported in literature, the treatment consisted in a total or partial excision of the tumor. Recurrence or malignant transformation was not found in any cases. The early and complete removal of this tumor is necessary for correct diagnosis and prevention of further growth. 

Conclusion

Leiomyoma in the glans is a very rare condition. Localization in the glans, especially in children, is very rare.  Even though confined to the subcutaneous layer, the growth of this tumor could lead to further difficulties in the excision and subsequent reformation of the glans with possible major effect. Early diagnosis and complete removal of tumor could be the best possible way from an aesthetic and on a functional point of view.

Suggested Reading

  1. Belis JA, Post GJ, Rochman SC, Milam DF. Genitourinary leiomyomas. Urology 1979; 13: 424- 429.
  2. Leoni S, Prandi S, Mora A. Leiomyoma of the prepuce. Eur Urol 1980; 6: 188-189
  3. Stehr M, Rohrbach H, Schuster T, Dietz HG. Leiomyom der Glans Penis [Leiomyoma of the glans penis]. Urologe A 2000; 39: 171-173. 
  4. Redman JF, Liang X, Ferguson MA, Savell VH. Leiomyoma of the glans penis in a child. J Urol 2000; 164: 791. 
  5. Bartoletti R, Gacci M, Nesi G, Franchi A, Rizzo M. Leiomyoma of the corona glans penis. Urology 2002; 59: 445

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