Journal of Cosmetics, Dermatological Sciences and Applications, 2012, 2, 214-215
http://dx.doi.org/10.4236/jcdsa.2012.23039 Published Online September 2012 (http://www.SciRP.org/journal/jcdsa)
Penile Epidermoid Cyst Consisted of Multiple Foci: A Case
Report
Akiou Okumura1, Kiyoshi Takagawa2, Hideki Fuse3
1Department of Urology, Kurobe City Hospital, Toyama, Japan; 2Department of Clinical Laboratory, Kurobe City Hospital, Toyama,
Japan; 3Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama,
Toyama, Japan.
Received May 15th, 2012; revised June 21st, 2012; accepted July 6th, 2012
ABSTRACT
Penile epidermoid cysts are uncommon, and a small number of cases have been reported worldwide. We present the
first documented patient with a penile epidermoid cyst which consisted of multiple foci. A 37-year-old man presented to
our department with a chief complaint of an asymptomatic, soft mass in the ventral part of the penis. The mass was not
tender, freely movable and measuring 3 cm within the dermis. MRI (magnetic resonance imaging) revealed a high sig-
nal intensity on both T1- and T2-weighted images. Excision of the cyst was performed under local anesthesia. Macro-
scopically, the cut surface of the mass appeared to be full of a cheese-like material and the cyst consisted of multiple
foci. The cyst did not contain skin appendages. The pathological diagnosis was an epidermoid cyst of the penis. No re-
currence has been noted in the year since the operation.
Keywords: Penis; Epidermoid Cyst; Multiple Foci
1. Introduction
Epidermoid cysts are the most common cutaneous cysts,
and these lesions can be found anywhere on the body, in-
cluding the genitalia [1]. They are particularly common
on the scrotum. On the other hand, penile epidermoid cysts
are uncommon and usually congenital. The etiology is
unknown, but it may represent a monolayer teratoma of
germ cell origin or an abnormal embryogenic closure of
the median raphe [2-4]. We report the first documented
case of a penile epidermoid cyst which consisted of mul-
tiple foci.
2. Case Report
A 37-year-old man presented to our department with a
chief complaint of an asymptomatic, soft mass in the
ventral part of the penis (Figure 1). He had no history of
penile trauma, inflammation, urinary tract infection, he-
maturia or dysuria. The mass was not tender, freely mov-
able, and measuring 3 cm within the dermis. MRI re-
vealed a high signal intensity on both T1- and T2-weight-
ed images within the ventral part of the penis, indicating
concentrated proteinic fluid within the cyst (Figure 2).
MRI highly suggested an epidermoid cyst of the penis.
Excision of the cyst was performed under local anes-
thesia. Macroscopically, the cut surface of the mass ap-
Figure 1. Soft mass in the ventral part of the penis.
(a) (b)
Figure 2. MRI revealed high signal by T1 emphatic inten-
sity image within the ventral part of the penis. Arrows indi-
cate the cyst of the penis. (a) Transverse section; (b) Sagital
section.

Penile Epidermoid Cyst Consisted of Multiple Foci: A Case Report 215
peared to be full of a cheese-like material and the cyst
consisted of multiple foci. Histological examination re-
vealed that the wall was lined with squamous epithet-
lium and laminated keratin (Figure 3). The cyst did not
contain skin appendages. The pathological diagnosis was
an epidermoid cyst of the penis. No recurrence has been
noted in the year since the operation.
3. Discussion
Penile epidermoid cysts are uncommon, and a small num-
ber of cases have been reported worldwide. Histologi-
cally, they are lined by well-developed stratified epithe-
lium without a skin appendage, and are composed of
keratin-producing epithelium [4,5]. Although the etio-
logy is unknown, some reports have suggested that the
cyst may originate from a median raphe cyst, possibly
arising from abnormal embryological closure of the me-
dian raphe or, rarely, may be acquired after mechanical
implantation such as that involving the injection of an
epidermal fragment [4,6]. Khanna [7] proposed the criteria
for a penile epidermoid cyst, whereby the cyst should be:
1) surrounded by penile tissue; 2) filled with keratin only;
3) lined with surrounding fibrous connective tissue; 4)
and with an inner lining of stratified squamous epithe-
lium and without dermal appendages. This case fulfilled
all these criteria.
Penile cysts or male genital cystic diseases occur in the
various sizes, but they are usually solitary. Among the
diseases, urethral diverticula and urethrocutaneous fistula
are important, but can usually be ruled out by both physi-
cal examination and the conditions evident upon voiding
[4]. Unlike urethal diverticula, epidermoid cysts do not
Figure 3. Histological aspect of the wall. The wall was lined
with squamous epithelium and laminated keratin (H-E).
communicate with the urethra. In our case, the cyst did
not communicate with the urethra and did not affect uri-
nation. Although rare, the extension of a cyst into the
pelvis has been reported [8]. In such cases, MRI is the
most useful modality for depicting the boundaries of the
lesion [8]. In this case, MRI was useful to clarify the
margin of the disease and investigate the characteristics
of the cyst.
In treatement for an epidermoid cyst, simple complete
excision has been regarded as the best treatment proce-
dure [4]. Although they are usually not painful, rupture
of the cyst wall can lead to a severe inflammatory reac-
tion that is extremely painful, and definitive treatment
requires surgical excision of the entire cyst wall to pre-
vent cyst recurrence [1]. Aspiration or simple drainage
may carry a risk of recurrence. There have been no re-
ported cases of malignancy involving a penile epider-
moid cyst. This case is the first penile epidermoid cyst to
be reported which consisted of multiple foci.
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