Résumé
Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis (PKMB).Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from Janumy 2008 to December 2013.Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients,and none of the patients had received prepucectomy.Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation,whose surfaces were covered with grayish yellow,adherent and hard micaceous crusts.Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis,epidermal pseudoepitheliomatous hyperplasia,thickened spinous layer,and normal cell polarity in the epidermis,as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis.Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus (HPV) in 2 cases.Two patients took small doses of prednisone,but achieved no obvious improvement.Oral isotretinoin had resulted in a favorable outcome in another two cases,but relapse occurred after dose reduction,and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream,or carbon dioxide laser treatment and photodynamic therapy.Conclusions PKMB is a chronic and obstinate disease,and should be diagnosed based on pathological findings.Its treatment is difficult,and tretinoin has some effects,but relapse often occurs after drug withdrawal and maintenance treatment is needed.
Résumé
Pseudoepitheliomatous, keratotic, and micaceous balanitis is an extremely rare condition occurring over the glans in elderly characterized by silvery white plaque with mica-like crust, which can undergo malignant transformation. Herein we present a case of pseudoepitheliomatous, keratotic, and micaceous balanitis occurring in an adult male presenting as a cutaneous horn.
Résumé
Pseudoepitheliomatous, keratotic and micaceous balanitis is a rare distictive clinical entity that represents a histologic spectrum ranging from hypertrophic hyperpalstic penile dystrophy to verrucous carcinoma. This condition is thought to be a malignant growth potential by resistance to treatment and its tendency toward local recurrence. We report two cases with similar clinical presentation of hyperkeratotic plaque and micaceous scaly patches on the glans penis that were compatible with pseudoepitheliomatous, keratotic and micaceous balanitis. Histopathologically, case 1, 48 year-old male was progressed to squamous cell carcinoma and case 2, 78 year-old male, was shown pseudoepitheliomatous hyperplasia without malignant changes.