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Tyson's "Glands"

Ectopic Sebaceous Glands and Papillomatosis Penis


Arthur B.Hyman, MD, New York, and CPT Martin H. Brownstein, MC, USAR,
Fort Eustis, Va

Tyson noted macroscopic lesions on the corona In the most recent edition of Gray's Anato
of the penis, interpreting them as the source of my of the Human Body it is stated3:
smegma. Later authors described the same lesions Scattered glands are present on the neck of
under such terms as papillomatosis corona penis. the penis and inner layer of the prepuce, the
Though the connective tissue nature of the papil- preputial glands (Tyson). They secret a seba
lomatous protrusions was recognized, they did ceous material of very peculiar odor, which
not equate the condition with that previously ob- readily undergoes decomposition; when mixed
served by Tyson. with discarded epithelial cells it is called smeg
Since Tyson had used the term "gland," micro- ma.
scopists who found ectopic sebaceous glands on The purpose of this communication is to
the glans and prepuce referred to them as Tyson's
clarify the natureof the lesions which Tyson
glands, although they are not what Tyson de- observed and which are not glandular, and
scribed. Neither papillomatosis corona penis nor
to consider glandular structures which he
ectopic sebaceous glands appear to play a role
in the formation of smegma; papillomatosis is not did not observe, but which have been attrib
glandular and smegma is not a secretion. It is uted to him.
suggested that the term Tyson's glands be re-
placed by the appropriate descriptive expressions: Papillomatosis Corona Penis
papillomatosis corona penis or ectopic sebaceous
glands. On the corona of the penis, and also on
the adjacent sulcus, there is often seen an
incomplete circle of skin-colored, white, or
J. N 1694 William Cowper wrote1: pink, papillomatous excrescences (color Fig
In that part where the Praeputium is contig 1 and 2). These areusually hemispheric
uous to the Balanus, my very good Friend that papules, though they may have acuminate
Judicious Anatomist, Dr. Tyson, has Discov or cylindrical form, they tend to be of fairly
ered certain small Glands which he calls
. . .
uniform size in any particular patient and of
from the great scent their separated Liquor no more than 3 mm in diameter. They are
emits, Glandulae Odoriferae; their Number is arranged in about one to five rows, are
uncertain; in those that have the Praeputium more densely distributed on the dorsal coro
longer than ordinary, they are not only more, nal edge, often converging to a single row on
but also larger, and separate a greater quantity
of the Juice, which being lodged there, often
the lateral margins, and disappearing to
grows Acrid and corrodes the Glans.
ward the frenulum. Occasionally the papules
In are seen neflr the frenulum, sometimes even
1904, Keith
and Shillitoe commented2:
in the absence of coronal involvement.
. failed to find any trace of Tyson's glands
. we
which have been described in every text-book
.
On microscopic examination, varying pro
of anatomy published since Tyson's time. To portions of fibrous and angiomatous prolif
quote from the latest edition of Quain's Anato eration are to be seen (Fig 1). Sebaceous
my: 'Numerous sebaceous glands are collected and other glandular structures are absent.
round the cervix of the penis and corona glan- We have found these lesions in nearly one
dis; they are named the glands of Tyson or quarter of a group of over 200 men attend
glandulae odoriferae, their secretions having a ing a dermatology clinic for unrelated prob
peculiar odour.' It shows the strength of the lems. Most patients are unconcerned about
faith of anatomists that they have for nearly two
centuries described glands which have not, and their condition; those who are aware of it
never had, an existence. usually state that it has been present for as
long as they can remember. In some cases
Accepted for publication July 8, 1968. the lesions had been previously diagnosed
From the Beth Israel Medical Center New York and treated as warts.
(Dr. Hyman) and McDonald Army Hospital Fort Papillomatosis corona penis is nearly al
Eustis, Va (CPT Brownstein).
Reprint requests to 2 W 87th St, New York 10024 ways asymptomatic and rarely requires
(Dr. Hyman). treatment. The application of podophyllin is

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without therapeutic effect. The individual ties papillaris penis,1013 hirsutoid papillo-
lesions can be satisfactorily removed by des mas of coronal margin of glans penis,14 and
siccation or ablation level with the sur pearly penile papules.15-16
rounding tissues; we have not seen recur Ectopic Sebaceous Glands
rences following these forms of treatment.
The problems of differential diagnosis are Multiple symmetric barely elevated dis
few. In contrast to penile warts, these le crete yellowish papules may be seen on the
sions are usually neatly arranged, uniform glabrous portions of the penile shaft. They
in size and shape, and show no substantial are asymptomatic and are rarely recognized
change with time. by the patient; they are usually more nu
Though the natural history of the condi merous on the ventral surface than on the
tion has apparently not been followed from dorsum, and become prominent when
more
its first appearance to its ultimate status in the skin is stretched. The papules are about
adult life, it is harmless, and uncomplicated millet-sized, and may number more than
by maceration, ulcration, hemorrhage, py- 100. We have found them in about one third
ogenic infection, or malignancy. The cause of adult men attending a dermatology clinic.
is unknown; it is probably of hamartoma- On histologie examination sebaceous glands
tous nature. There is no evidence that it is are found in the upper cutis, and these
related to glandular structures, or caused by usually appear to be unassociated with fol-
a virus or other infectious agent. As far as licular structures.
we know it has no sensory or stimulatory In some cases the lesions are more promi
affects in coitus. nent (color Fig 3). The patient himself of
The condition was discussed by Littre4 in ten makes the observation that a cheesy
1700 and Duverney5 in 1761. It has subse material can be expressed from them. In
quently been described under a variety of these, histologie examination shows ob
terms including: papillae of the glans penis,6 structed ducts leading from the sebaceous
papillae of the corona of the glans,7-9 hirsu- glands to the surface, or small follicles with

Fig 1.Two adjacent lesions of papillomatosis of the corona showing fibrovascular


protrusions of the cutis surrounded by epidermis, with rather thick laminated keratin.

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Fig 1.Papillomatosis of the corona, dorsal Fig 2.Papillomatosis of the corona, dorsal
aspect. aspect.

Fig 3.Sebaceous glands and milial cysts of Fig 4.Ectopic sebaceous glands of the pre
the shaft of the penis. puce.

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Undoubtedly others have seen these le
sions, perhaps without recognizing their
specific nature. Sebaceous glands and milia
of the shaft of the penis are harmless; eradi
cation is rarely required. Lichen nitidus
might be considered in differential diagno
sis, but the papules of sebaceous glands and
milia are usually yellowish rather than
white and glistening, dome-shaped and
round rather than flat and angulated. Histo
logie examination would immediately distin
guish between the conditions.
Sebaceous glands in skin are usually asso
ciated with hair follicles to form piloseba-
ceous units; however, in regions of transi
tion between skin and mucous membranes,
and occasionally in true skin, they may
occur independently.17 In man, in contrast
to some of the higher mammals, the distal
Fig 2.Photomicrograph of milial cyst of shaft of
penis. This contains three roughly concentric collections two thirds of the penis is ordinarily free of
of keratin, which, towards their centers, show debris hair.
and fragments of hair.
A few instances of ectopic sebaceous
glands of the prepuce have been observed on
cystic dilation occupied by laminated kera microscopic examination of multiple sections
tin, amorphous material, and a few small of macroscopically normal tissue. Sousa18
hairs (Fig 2). found sebaceous glands in the prepuce of
Fig 3.Sebaceous glands of the mucosal aspect of the prepuce. They lie free in the
cutis, surrounded by loose stroma, with no evident relationship to follicles.

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one patient after examining serial sections tosis corona penis or ectopic sebaceous
of tissue from 30 individuals. We have glands, as the case may be.
found only one report19 in which the pres The cost of color reproduction was supported by
ence of sebaceous glands on the prepuce,
a grant from Mr. Charles A. Oclassen, Westwood
Pharmaceuticals, Buffalo, NY.
clinically recognized, was corroborated by
microscopic examination. We have now seen References
more than a dozen similar cases, with pin- 1. Cowper, W.: Myotomia Reformata: Or, A New
head sized, yellowish lesions on the mucosal Administration of all the Muscles of Humane Bodies;
Wherein the true Uses of the Muscles are Explained,
aspect of the prepuce, and a tendency to the Errors of former Anatomists concerning Them
grouping, which were clinically recognized Confuted, and several Muscles not hitherto taken
as sebaceous glands (color Fig 4). Most of notice of Described; To which are subjoin'd A Graph-
ical Description of the Bones; And other Anatomical
our patients also had prominent sebaceous
Observations, London: Sam. Smith and Ben. Walford,
glands on the shaft of the penis, and in 1694, pp 228-229.
several a few hairs were noted on the distal 2. Keith, A., and Shillitoe, A.: The Prepucial or
Odoriferous Glands of Man, Lancet 1:146-148 (Jan
third of the shaft. We have had the opportu 16) 1904.
nity to examine specimens of the mucosa of 3. Gray, H.: Anatomy of the Human Body, ed 28,
the prepuce in three of our patients, and lishersC.M.
Goss, (ed.), Philadelphia: Lea & Febiger, Pub-
1966, p 1309.
histologically confirm the presence se
to of 4. Littr\l=e'\:Sur les Parties Destin\l=e'\esa la Generation,
baceous glands which had been clinically Histoire de l'academie des sciences: Ann\l=e'\eMDCC,
Paris, 1703, pp 29-35.
recognized (Fig 3). 5. Duverney: Oeuvres Anatomiques, Paris: Charles-
Sebaceous glands have been observed mi Antoine Jombert, 1761, vol 2.
6. Gutmann, C.: \l=U"\berdie papillen der glans penis,
croscopically on the glans.20 We could find Dermat Zbl 13:290-298 (July) 1910.
no report of sebaceous glands on the corona 7. Buschke, A.: Ueber die Bedeutung der "Papil-
of the penis. len" der Corona glandis, Klin Med 5:1621-1623 (Oct
24) 1909.
8. Buschke, A., and Gumpert, M.: Die Papillen an
Comment der Corona glandis in vergleischenanatomischer und
ethnologischer Beziehung', Arch Frauen K 11:43-55,
1925.
The macroscopic lesions on the corona 9. Nexmand, P.-H.: Papillae corona glandis, en
observed by Tyson, which he assumed to be normal-anatomisk variant med differentialdiagnoskisk
of glandular nature and responsible for the betydning, Ugeskr Laeg 116:1323-1324 (Sept 16)
1954.
acrid odor, would appear to be identical 10. Majocchi, D.: Hirsuties papillaris penis (Papil-
with what subsequent authors have de lae coronae glandis): Nota clinico-istologica ed
G Ital Mal Vener 65:574-578
scribed under such terms as papillomatosis anatomo-comparata,
(April) 1924.
corona penis. Some writers recognized these 11. Ferrer: Hirsuties Papillaris Penis (Majocchi),
lesions as connective tissue protrusions, but Arch Derm Syph 19:157 (Jan) 1929.
12. Wigley, J.E., and Haber, H.: Hirsutes Papil-
did not correlate the condition with that laris Penis, Brit J Derm 61:427 (Dec) 1949.
described by Tyson. It has seldom been 13. Cordivola, L.A.; Sanchez Caballero, H.J.; and
P.: Hirsuties papillaris penis de Maiocchi,
expressly stated that they are to be equated. Bosq,
Sem Med 110:908-909 (June 20) 1957.
Since Tyson had used the term "gland" in 14. Winer, J.H., and Winer, L.H.: Hirsutoid Papil-
connection with penile lesions, some investi omas of Coronal Margin of Glans Penis, J Urol
74:375-378 (Sept) 1955.
gators who found ectopic sebaceous glands 15. Johnson, B.L., Jr., and Baxter, D.L.: Pearly
of the prepuce and glans applied his name Penile Papules, Arch Derm 90:166-167 (Aug) 1964.
to this condition.21 Others who sought seba 16. Glichsman, J.M., and Freeman, R.G.: Pearly
Penile Papules: A Statistical Study of Incidence,
ceous glands in these parts and did not find Arch Derm 93:56-59 (Jan) 1966.
them denied the existence of Tyson's 17. Hyman, A.B., and Guiducci, A.A.: "Ectopic
Sebaceous Glands," in Montagna, W.; Ellis, R.A.;
"glands."22 and Silver, A.F., (eds.) Advances in Biology of Skin,
Smegma is not formed by papillomatosis
vol 4, The Sebaceous Glands, London: Pergamon
corona penis or ectopic sebaceous glands, Press, 1963, pp 78-93.
18. Sousa, O.M. der Sur la pr\l=e'\sencede glandes
but is the result of desquamatedepithelial s\l=e'\bac\l=e'\es au niveau du gland chez l'Homme, C R
cells of the glans and prepuce, maceration, Soc Biol 108:894-897 (Dec) 1931.
and contamination with bacteria. 19. Goeckerman, W.H.: Fordyce's Condition of the
Penis, Arch Derm Syph 14:50-52 (July) 1926.
For the sake of clarity and in order to 20. Saalfed, E.: Ueber die Tyson' schen Dr\l=u"\sen,
avoid continued confusion, it is suggested Arch Mikr Anat 53:212-218 (Nov 18) 1898.
21. Koelliker; Ueber die Tyson' schen Dr\l=u"\sendes
that except for historical references, the Menschen, Verh Anat Ges 11:7-8 (Aug 15) 1897.
term Tyson's glands be replaced by the ap 22. Stieda, L.: Ueber die vermeintlichen Tyson'
propriate descriptive expression, papilloma- enschen, Verh Anat Ges 11:7-8 (Aug 15) 1897.

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