Dinesh Kumar Barolia
Penile cutaneous horn-a rare case

Barolia DK1, Sethi D2, Sethi A3, Ram J4, Meena S5, Rachhoya P66

1Dr Dinesh Kumar Barolia, 2Dr Deepak Sethi, 3Dr Anjali Sethi, 4Dr Jamana Ram, 5Dr Shanker Meena, 6Dr Pinky Rachhoya

1, 2, 4, 5,Department of General Surgery, R.N.T. Medical College, M.B. Government Hospital, Udaipur, Rajasthan, India, 3Department of General Surgery, Pacific Medical College and Hospital, Udaipur, Rajasthan, India 313001, 6Department of Obstetrics and Gynecology, R.N.T. Medical College, M.B. Govt. Hospital, Udaipur, Rajasthan, India

Address for Correspondence: Dr Dinesh Kumar Barolia, Email: dbaroliarnt@gmail.com



Abstract

Penile cutaneous horn is a horn like hyper-keratotic lesion over penis which is an unusual site and a rare case. We report a case of cutaneous horn of penis in age of 20 years which is also a rare presentation in this age group.

Key words: Cutaneous Horn, Penile Cutaneous Horn, Penile Horn



Manuscript Received: 20th Sept 2015, Reviewed: 4th Oct 2015
Author Corrected: 10th Oct 2015, Accepted for Publication: 14th Oct 2015

Introduction

Cutaneous horns are also known as cornucutaneum, which are unusual keratinous skin tumors with the appearance of horn. This is clinically appears as conical projection above the surface of the skin [1]. Although the cutaneous horn may develop over a normal skin, these more often develop over some pre-existing skin conditions like warts, keratosis, nevi, trauma, burns, lupus vulgaris, and even on an epithelioma[2]. Cornucutaneum (cutaneous horn) is a well-defined cone-shaped lesion with hyper-keratotic features. This type of lesion mostly found on exposed skin [3]. Cutaneous horns occur rarely on the penis. The incidence of the lesion is very low, with only 30 cases reported in 25 years [4]. Disease may be benign in 42%-56%, premalignant in 22%-37%, or frankly malignant in 20%-22% of patients [5].

Case Report
 
We report a case of cutaneous horn at unusual site over penis. A twenty one year old male presented in hospital with conical shape hard swelling over ventral surface of penis. He noticed the lesion one year back. Before one year he was having the complaint of phimosis. Therefore he was operated circumcision. After two months of circumcision he develops the lesion. The lesion was gradually increased in size. When he came to hospital, lesion was conical in shape, hard in consistency, over ventral surface of penis and near about three centimeter in size. Horn was surgically excised with free margine. Histopathology of tissue at base of cutaneous horn shows hyperplastic squamous epithelium with marked hyper keratosis. There was no evidence of malignancy. This patient discharged without any complication with satisfactory result. In follow up patient was satisfied with surgery and having no complain.

Discussion

Cutaneous horn (synonyms; Cornucutaneum: Cornuhumanum) is a conical, hyper-keratotic protrusion that often resembles like an animal horn. The term "cutaneous horn" is not a true diagnosis. It is named after morphologic appearance like animal horn. To this date just >150 cases have been reported in the literature [4].The factor which leads to these patients developing penile horn is unclear. The roles of chronic irritation, phimosis, surgical trauma and radiotherapy that have been implicated in penile horn formation have also been found to predispose to carcinoma penis [1,6]. Cutaneous horn may be benign, premalignant or malignant. The etiology of penile cutaneous horn remains uncertain. The earliest documented case of cutaneous horn, or cornucutaneum, of an elderly Welsh woman in London who was displayed commercially as an anomaly of nature in 1588 [6]. The first case report of penile cutaneous horn was published in 1854[7]. The European Association of Urology guidelines on penile cancer they consider penile cutaneous horn as a premalignant lesion and approximately one-third of penile cutaneous horns are associated with an underlying malignancy[8,9].

Recently, several studies indicated that immune-histochemical expression of p16ink4a may be used not only as a marker of high-risk HPV infection, but also on differential diagnosis of penile epithelial abnormalities and precancerous lesions. Earlier data showed strong association of HPV with high-grade squamous cell carcinoma, whereas well-differentiated SCC subtypes were not HPVrelated. Chaux et al. Have published a study designed to seek an immune-histochemical profile that can be helpful in the classification and differential diagnosis of penile epithelial abnormalities and precancerous lesions[10].
Conclusion
Penile cutaneous horn is a rare case.Penile cutaneoushorn is a clinical diagnosis which is made on the basis of morphological appearance. Horn can be associated with benign or malignant condition. True diagnosis is proved after histopathological examination of tissue. We report this case of penile cutaneous horn with benign histopathology.

 figure01  figure02

Fig 1 and 2:  showing penile cutaneous horn around 3 cm in length

 figure03
Fig 3: Histopathological slide at base of penile cutaneous horn-showing hyperplastic squamous epithelium, keratin pearl with chronic inflammatory infiltration.(10X)

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

References 

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How to cite this article?

Barolia DK, Sethi D, Sethi A, Ram J, Meena S, Rachhoya P. Penile cutaneous horn-a rare case. Int J Med Res Rev 2015;3(9):1102-1104. doi: 10.17511/ijmrr.2015.i9.201.


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