Median Raphe Cyst of the Penis

Journal of Medical Case Reports
15 Jul, 2019 ,

A 29-year-old unmarried Nepali man presented to our clinic with an asymptomatic, solitary, soft, translucent, nontender cystic lesion of about 1-cm diameter at the ventral aspect of glans penis, close to the meatus, that had been noticed at the age of 3 and was nonprogressive for the past 15 years. Ultrasonography demonstrated an isoechoic cystic lesion at the tip of the penis, separated from the urethra, and lying entirely within the mucosa without any evidence of solid component, septation, or vascularity. On the basis of clinical and ultrasonographic findings, a diagnosis of median raphe cyst of the penis was made. The cyst was excised with the patient under local anesthesia, and there was no evidence of recurrence in 2 years of follow-up. The histopathological examination with Hematoxylin and eosin staining showed the cyst wall was lined partly by ciliated pseudostratified columnar epithelium and partly by columnar epithelium with apical mucin.

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A 29-year-old unmarried Nepali man presented to our clinic with a complaint of soft, painless swelling at the tip of the penis since childhood. His mother had noticed the swelling when the patient was at the age of 3, and the swelling had increased in size for a few years to reach its present dimension.

However, the swelling had been nonprogressive for the past 15 years. He had no complaints of pain, itching, burning, tenderness, discharge, trauma, or oozing. The lesion did not interfere with urination or penile erection. He did not have any history of congenital anomaly, any medical illness, or similar lesions in family members. The patient’s only concern was cosmetic and the possibility of interference in sexual activity, because he was planning to get married soon.

His physical examination revealed a solitary, soft, translucent cystic lesion of about 2-cm diameter at the ventral aspect of the glans penis, close to the meatus, but not involving the margins of the urethral orifice.

The overlying mucosa was shiny, whereas the surrounding mucosa was normal. The cyst  was soft and nontender on palpation. The urethral opening was not obstructed, and examination of other regions of the penis, scrotum, and perineal region were unremarkable. No palpable inguinal lymphadenopathy was seen. The results of the patient’s urinalysis and hemogram were normal. Ultrasonography (USG) of the cyst was advised, which demonstrated an isoechoic cystic lesion at the tip of the penis. There was no evidence of a solid component, septation, or vascularity within the cyst seen by USG. The urethra was separated from the cyst, which was entirely within the mucosa. On the basis of clinical and USG findings, a diagnosis of MRC of the penis was made.

The cyst was excised with the patient under local anesthesia. During excision, the cyst ruptured, releasing the mucinous content. The whole specimen was sent for histopathological examination. Hematoxylin and eosin (H&E) staining showed the cyst wall was lined partly by ciliated, pseudostratified columnar epithelium and partly by columnar epithelium with apical mucin. The lamina propria showed mild chronic inflammatory infiltrates. No features of dysplasia or malignancy were noted. IHC could not be done, owing to technical and financial reasons. The patient was followed for 1 year. The site of the excision healed without any residual effect. There were no issues related to urination or sexual activities. Recurrence was not observed during the 2-year follow-up period.