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We are grateful to Golitz et al for their reminder of the median raphe cyst, a lesion that we should have included in the differential diagnosis. However, we do not believe that our patient had a median raphe cyst. In most areas, the cyst excised from our patient was clearly lined by a double layer of cells: an inner layer of cuboidal to columnar secretory cells and an outer layer of myoepithelium. Transitional epithelium does not have a myoepithelial layer, nor does it exhibit a cuboidal or columnar architecture. In addition, the cytoplasm of the secretory cells contain PAS-positive, diastase-resistant granules that are characteristic of apocrine epithelium and that are not found in transitional epithelium. These findings are more consistent with our diagnosis of apocrine cystadenoma than with that of median raphe cyst.
Powell RF, Palmer CH, Smith EB. Penile Cysts and Canals-Reply. Arch Dermatol. 1978;114(5):802. doi:10.1001/archderm.1978.01640170096041
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