Pseudoepitheliomatous keratotic and micaceous balanitis: low-risk human papilloma virus detection in two further cases

Abstract

We report two cases of histologically documented pseudoepitheliomatous keratotic and micaceous balanitis in middle-aged male patients, which showed positivity for low-risk serotype human papillomavirus DNA. To our knowledge, only one other case has been documented. Further immunohistochemical proliferative markers were performed and compared to literature findings in penile epithelial proliferations. Evolution to invasive verrucous carcinoma has been associated with absence of HPV DNA. Thus, if confirmed by further studies, HPV testing should be included in pseudoepitheliomatous keratotic and micaceous balanitis assessment to address prognosis, and management.

Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases

“…23 One patient initially had residual disease at the graft site, treated successfully with salicylic acid and 5-flurouracil. Of 18 reported cases of the use of 5-flurouracil, 6,10,12,17,[24][25][26][27][28][29][30][31][32][33][34][35][36] significant improvement was seen in just five (27.7%). 25,27,33,36,37 Two cases treated with salicylic acid reported little improvement.…”

“…Excision of localized disease proved effective for one of our patients; there are also nine cases of this previously described, with varying results. 6,7,[17][18][19]23,35,38,39 Other modalities published include partial penectomy (3 cases), [40][41][42] cryotherapy (3 cases), 10,17,27 radiotherapy (2 cases), 9,43 acitretin (2 cases) 24,26 and photodynamic therapy (1 case). 44…”

“…Two men with PEKMB had low-risk HPV DNA detected, though no clinical or histological evidence of HPV, including negative p16 staining. 17 One case was deemed to have koilocytes on histology, however neither HPV DNA analysis or p16 staining were performed and published histological photographs were not of adequate quality for interpretation. 18 Kang et al described a further case in association with HPV detection on PCR (no subtype given), with no evidence of HPV on histology (p16 stain not performed).…”

“…Very few cases in the literature are described in association with HPV. Two men with PEKMB had low‐risk HPV DNA detected, though no clinical or histological evidence of HPV, including negative p16 staining 17 . One case was deemed to have koilocytes on histology, however neither HPV DNA analysis or p16 staining were performed and published histological photographs were not of adequate quality for interpretation 18 .…”