Median raphe cyst of the penis: Diagnosis and therapeutic approach

Abstract

Background: Penoscrotal or perineal median raphe cysts were first described in 1985 by Mermet, being very rare. The cysts may be located from the anus to the distal penis. They are injuries with easy diagnosis and congenital, although they are often diagnosed in adulthood, being totally benign. Case report:We report the case of 40-year-old man who consulted for ventral tumor in the penis, which had grown from a few months ago and affected his sexual experiences. The examination showed a mobile cystic tumor in ventral penis side, with the diagnosis of median raphe cyst. It was performed surgical excision of the lesion and the histologic diagnosis matched the clinical diagnosis. Six months later, the patient had no recurrence of the injury. Discussion: In a majority of patients, these injuries take years to manifest and often it do in adulthood. The formation of these cysts can be explained by embryologic anomalies or defects in the closure of the median raphe, sometimes related to the persistence of these embryonic remains during the closure of the urogenital folds or by the existence of hubs of embryologic epithelium trapped before closing pleats or because of abnormal development of ectopic periurethral glands (Littre). It is usually asymptomatic in 75% of cases. The clinical presentation usually occurs because of infection or ulceration of these cysts, discomfort during sex if the size is large, and urinary symptoms if it is located near the urethral meatus. It appears as pearly or cystic nodules, filled with translucent mucoid material that can be located from the distal penis following the same ventral raphe to the perineum. The differential diagnosis must be made with epidermal cysts, steatocystoma, glomus tumor, dermoid cyst, pilonidal cyst, or urethral diverticulum. Most authors recommend surgical excision only when it gives symptoms or is large (for cosmetic reasons, although it is asymptomatic). In contrast, other authors recommend routine excision to prevent episodes of superinfection or local discomfort related to location and size.