Pseudoepitheliomatous, keratotic, and micaceous balanitis

Abstract

A case of pseudoepitheliomatous, keratotic, and micaceous balanitis is described. This rare tumor of the glans penis was initially considered to be entirely benign. Evidence from this case and from previously published case reports suggests that this lesion may have locally invasive or aggressive tendencies and that it should be considered to have low-grade or limited malignant potential. Conservative surgical removal seems to be adequate therapy.

Pseudoepitheliomatous, Keratotic and Micaceous Balanitis

“…According to the cases pub lished in English literature [3, 4. 10, 12], topical therapy was claimed to be without value, and primary surgical excision or partial penile amputation were considered as the treatment of choice, especially if performed early in the premalignant stage [4,12]. Mascaro [5] reported an excellent response with topical 5-FU for primary and recurrent PEKMB in plaque stage, as was observed in our patient.…”

“…However, histologic fea tures reported in association with this unusual clinical entity have not been uniform. Previous case reports have suggested that this condition shows a low grade malignant growth potential clinically manifested by its resistance to treatment and tendency toward local recurrence [3,4]. Others, including our case, reported benign histopathological features with excellent response to topical 5-fluorouracil (5-FU) [5][6][7].…”

“…Initial plaque stage is characterized histologically by orthokeratosis, acanthosis, retained basal membrane continuity with bul bous basal contour but absent deep downgrowths, epithe lial dysplasia, atypical mitoses or architectural disarray of kératinocytes. This benign histology is retained in the tumor stage, although with a stepwise increase in benign hyperplasia reaching a climax in the large horny excres cence, a unique pathologic horn [4,6,11]. After a pro tracted course some of these horny lesions may show deep bulbous, squamous outgrowths, sinuses filled with kera tin, markedly increased basal cell activity indicated by increased cell density, variation in size and shape of the Pseudoepitheliomatous, Kcratotic and Micaceous Balanitis nuclei, and increased number of mitoses [3,10,12], This stage can be considered as third stage -transformation in the verrucous carcinoma.…”

“…Simple penile horns differ clinically from PEKMB in that they arise from a sharply demarcated base in finger-like projections, without preexisting plaque [14], They usually have benign clinical course but malignant transformation to squamous cell carcinoma has been reported in about one third of the cases [15], Treatment of PEKMB poses considerable difficulties. Topical therapy with 5-FU, high-and low-dose radiation, primary surgical excision and partial penectomy have all been suggested [4,5,7,9,12]. According to the cases pub lished in English literature [3, 4.…”

“…In conclusion, wc can say that the entity PEKMB is gross morphologic diagnosis that includes a spectrum of histologic features ranging from hypertrophic-hyperplas tic penile dystrophy to verrucous carcinoma and rarely frank invasion [3,4,11], These patients clearly need close observation with repeat biopsy to ensure the early diagno sis of malignant change. Radical surgical procedures are not warranted early in the course of PEKMB, a condition with indolent, recurrent character, delayed invasive ten dency and protracted course with our patient having been under observation for more than 2 years.…”