Profound Proliferating Pearly Penile Papules

Abstract

A 28-year-old white man complained of the progressive development of lesions affecting the glans penis. He claimed he was treated for condylomata acuminata affecting the penile shaft 4 years previously. At the same time, he noticed a "roughened area" on the corona. This area did not enhance with 5% acetic acid and thus was not treated by his local dermatologist.Over the next 4 years, the affected area grew, encompassing the entire dorsal and lateral glans penis. Four months prior to the patient's presentation at our institution, a shave biopsy was performed and interpreted as showing changes consistent with condyloma acuminatum. The patient was referred to an urologist who ruled out urethral involvement. He was then unsuccessfully treated by a second dermatologist with podophyllin prior to referral.At the time of presentation at our institution, the patient and his wife were distressed about the resistant and progressive nature of his lesions. In addition, they desired children, yet were concerned about transmission of venereal warts.Gross examination showed a coarse "velvety" appearance of the glans penis with the exception of the previous biopsy site (Fig. 1). Stretching the skin of the glans laterally revealed uniform rows of soft flesh-colored filiform papules running radially from the urethral meatus to the corona. There were a few papules affecting the sulcus of the glans penis but there were no papules on the penile shaft.Histopathologic examination of tissue obtained at our institution from the glans penis disclosed compact orthokeratosis overlying an acanthotic epidermis. Hypergranulosis and focally elongated rete ridges were noted. Within an expanded papillary dermis, there was a proliferation of ectatic capillaries lined by variably thin to plump endothelium, as well as increased numbers of plump, stellate-shaped fibroblasts with occasional multinucleation (Fig. 2). The background collagen demonstrated Increased, thickened fibers, and there was an infiltrate of lymphocytes and mast From the

Multiple Dense Papules on the Entire Glans: Profound Pearly Penile Papules

“…5 To date, only two case reports of PPP involving the entire glans have been published, with the first by Vesper in 1995. 6,7 This variant was described as profound PPP, thereby expanding the disease spectrum. As compared to previous reports, the presentation of our case is more obvious and typical.…”

Diagnosis and Management of Pearly Penile Papules

“…The prevalence declines in older patients, suggesting that the lesions regress with age (Agha et al, 2009; Glicksman & Freeman, 1966). Circumcised males have lower rates of PPP, possibly due to chronic abrasion to the exposed corona causing lesion regression (Agha et al, 2009; Michajlowski et al, 2012; Neinstein & Goldenring, 1984; Vesper, Messina, Glass, & Fenske, 1995). There is some evidence that PPP are more common in the Black population (Rehbein, 1977), but many studies have reported no association with race (Glicksman & Freeman, 1966; Neinstein & Goldenring, 1984).…”

“…The histological findings include increased epidermal melanocytes overlying a prominent granular zone with absent basal layer pigment (Glicksman & Freeman, 1966; Neinstein & Goldenring, 1984). Increased vasculature is seen in the upper dermis with focally elongated rete ridges (Oates, 1997; Ozeki et al, 2008; Vesper et al, 1995; Watanabe et al, 2010). The dermis also contains infiltration of lymphocytes and histiocytes (Oates, 1997; Ozeki et al, 2008).…”