Peyronie disease (PD) is a benign, superficial fibromatosis involving the fascial structures of the penis, causing deformity, pain, and loss of function, for which there are few contemporary studies of the histopathology. We performed a multi-institutional review of 74 routine and consultation specimens submitted with clinical concern for PD. Of these, three non-PD lesions were identified and excluded (a myointimoma, a mammary-type myofibroblastoma, and fibrocalcific atherosclerosis). Of the 71 confirmed to be PD, the majority of patients were white (83%) with a median age of 55 years (range: 26-88). The dorsal aspect of the penis was the most common site involved (78%), followed by lateral (12%) and ventral (10%). The median degree of curvature was 70° (range: 20-360°). On review, three overall histologic patterns characterized the lesions resected: dense fibrotic plaque (61%), dense fibrotic plaque with focal or patchy metaplastic ossification (35%), and plaque composed predominantly of metaplastic ossification (4%). The fibrotic component was predominantly nodular (18%), hyalinized/lamellar (46%), or mixed (32%), excepting two cases consisting entirely of metaplastic bone. Chronic inflammation, when present, was most often focal and perivascular in distribution. In one case, an excision post collagenase treatment, showed myxoid change and increased stromal cellularity. Overall, these findings define the range of PD histology, particularly emphasizing that the "calcification" noted clinically nearly always represents bona fide metaplastic ossification. Such context will be of value in evaluating specimens prospectively, in light of changing practices and the use of new technologies for treatment.
Human pathology. 2020 Jul 15 [Epub ahead of print]
Bryce Shawn Hatfield, Caleb Robert King, Aaron M Udager, Sean R Williamson, Jatin S Gandhi, Mahul B Amin, Laura Spruill, Kathryn Grace Lindsey, Raghavendra Pillappa, John Tyler Roseman, Mark Cameron Mochel, Steven Christopher Smith
Department of Pathology, VCU School of Medicine, Richmond, VA, 23298, USA. Electronic address: ., Department of Pathology, VCU School of Medicine, Richmond, VA, 23298, USA., Department of Pathology, Michigan Medicine, Ann Arbor, MI, 48103, USA., Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI 48202, USA., Department of Pathology and Laboratory Medicine and Department of Urology, University of Tennessee Health Sciences Center, Memphis, TN, 38103, USA., Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA., Division of Urology, Department of Surgery, VCU School of Medicine, Richmond, VA, 23298, USA., Department of Pathology, VCU School of Medicine, Richmond, VA, 23298, USA; Division of Urology, Department of Surgery, VCU School of Medicine, Richmond, VA, 23298, USA.