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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 45-47

Pseudoepitheliomatous, keratotic and micaceous balanitis




Correspondence Address:
B Mohan Gharpuray


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  Abstract 

Two patient aged 56 and 18 years respopectively, developed pseudoepitheliomatous, keratotic, and micaceous balanitis on their glans. One of them developed a malignancy 6 years later.


Keywords: Balanitis, Pseudoepitheliomatous, Keratotic. Micaceous


How to cite this article:
Gharpuray B M, Joshi P B, Patki H A, Lohalikar A. Pseudoepitheliomatous, keratotic and micaceous balanitis. Indian J Dermatol Venereol Leprol 1990;56:45-7

How to cite this URL:
Gharpuray B M, Joshi P B, Patki H A, Lohalikar A. Pseudoepitheliomatous, keratotic and micaceous balanitis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Aug 21];56:45-7. Available from: http://www.ijdvl.com/text.asp?1990/56/1/45/3480


Pseudoepitheliomatous, keratotic and mica­ceous balanitis (PKMB) is an extremely rare penile disorder. PKMB was first described by Lortat-Jacob and Civatte in 1966.[1] Read and Abell[2] reported a case of PKM B in 1981 which they thought to be the fourth reported case. Bargman[3] states in his report in 1985 that his case was the third reported case in the english literature.

PKMB is characterized by thick, micaceous scales on the glans penis. It is usually seen in uncircumcised elderly men. It is slowly pro­gressive and is believed to be locally invasive. We are reporting two cases of PKMB for their variation from the cases reported so far.


  Case Reports Top


Case 1

A 56-year-old male patient reported with pain and discomfort because of a dry keratotic lesion on the glans penis for two years. He was able to remove the scales with rubbing which would leave behind an erythematous scaly area. The scales however, formed again quickly. He had observed that the scales, if not removed, separate from the glans in some areas and continue to grow horizontally from the fixed base to form a flap over the glans [Figure - 1]. The patient could break this flap but could not dislodge it from its base. The penile shaft, scrotum and inguinal regions were normal. There was no regional lymphadenopathy. General and systemic examination revealed no abnormality. Routine investigations were normal. Histopathological studies revealed massive hyperkeratosis and marked lobular acanthosis.

Triamcinolone acetonide cream (0.1%), 5­fluorouracil lotion (1 %) and podophylline appli­cation (20%) were tried one after the other without any benefit. Local excision biopsy gave only a temporary relief followed by re­currence in six months.

The patient was kept under observation for four years during which period he was applying oil to the lesion to keep the part soft. After six years since the original complaint started, the patient started getting local pain and was asked to undergo partial amputation of penis, The histopathological studies at this time revealed a low grade squamous cell carcinoma. Six months after the surgery, the patient had no evidence of local recurrence or regional lymphadenopathy.

Case 2

An eighteen-year-old male patient had slowly progressive papulo-squamous lesions on glans penis for 11 years. These were associated with itching and burning sensation. Later on, he developed similar lesions on the coronal sulcus. One of the papular lesions grew -sub in height like a horn. The patient was able to break this lesion when it was of sufficient height but was not able to dislodge it from the base.

Clinical examination revealed the glans penis to be dry and inelastic. There was a micaceous, keratotic, horn-like growth arising from the coronal sulcus [Figure - 2]. The prepuce was permanently retracted behind the horn. The penile shaft, scrotum and inguinal regions were normal. General and systemic examination as well as routine investigations did not reveal any abnormality. Biopsy taken from the area where the horn-like projection was seen, revealed massive hyperkeratosis, hypergranulosis and acanthosis [Figure - 3]. An ectoparasite without any surrounding inflammation was seen in one field of the hyperkeratotic lesion.


  Comments Top


Pseudoepitheliomatous, keratotic and mica­ceous balanitis is a rare type of balanitis believed to occur in elderly men. One of our cases was an eighteen-year-old boy. Since the association of PKMB and malignancy is a distinct possibility, its occurrence at the age of 18 years is note­worthy.

Cases reported by Read and Abell, 2 and Bargman 3 clinically differ from our cases. The characteristic feature in their cases was the heaped up micaceous scaling over glans penis and coronal sulcus. Our cases revealed scaly, inelastic glans penis as in their cases, but the overgrowth of micaceous material either verti­cally or horizontally from a fixed base appears to be significantly different from previously reported cases. Unlike the cutaneous horns which are not easily broken, our patients were able to break these over-growths rather easily.

Histopathological studies at an early stage showed massive hyperkeratosis and acanthosis.

The ectoparasite seen in one case was probably an accidental finding as there was no inflamma­tory response. One of the cases showed mali­gnant transformation after six years. However, radical surgery is not advisable in every case as the condition is of indolent character and has a delayed invasive tendency.

 
  References Top

1.Domonkos AN, Arnold HL Jr and Odom RE Andrew's Diseases of the Skin, Seventh ed.. WB Saunders, Philadelphia, 1982; p 834.  Back to cited text no. 1    
2.Read SI and Abell E : Pseudoepitheliomatous, keratotic, and micaceous balanitis, Arch Dermatol, 1981 ; 117 : 435-437.  Back to cited text no. 2    
3.Bargman H : Pseudoepitheliomatous, keratotic, and micaceous balanitis, Cutis, 1985; 35 : 77-79.  Back to cited text no. 3    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Pseudoepitheliomatous, keratotic, and micaceous balanitis
Murthy, P.S., Kanak, K., Raveendra, L., Reddy, P.
Indian Journal of Dermatology. 2010; 55(2): 190-191
[Pubmed]



 

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