Review of 120 Biopsies Performed on the Balanopreputial Sac

Abstract

Background: Long-lasting erythematous lesions involving the balanopreputial sac may be clinically difficult to classify, and biopsies may be performed in order to clarify the nature of the disease. However, our previous experience led us to consider several cases as histopathologically unclassifiable. Objective: To establish the causes of such unsatisfactory findings. Methods: We reviewed 120 balanopreputial sac biopsies performed at the surgical unit of our institute from January 1999 to December 2002 examining also the patients’ clinical records. Results: We found that a small group of previously unclassified cases showed common clinical and histopathological features. Clinically, all patients were uncircumcised and had long-lasting asymptomatic erythematous plaques on the balanopreputial sac with no erythroplastic or lichenoid features and no correlation with sexual intercourse. Histologically, all specimens showed a thinned and spongiotic epithelium, a band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation. Conclusions: In our view, these cases fall within a spectrum of inflammatory non-cicatricial disorders, ranging from almost pure lymphohistiocytic forms to forms which fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon. We propose to classify these cases histologically as inflammatory non-cicatricial balanoposthitis and clinically as idiopathic inflammatory non-cicatricial balanoposthitis.

Successful Management of Zoon’s Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacelluaris

“…Typically the condition is asymptomatic, though pruritus or tenderness may be present [2, 8]. The lesions may occur co-incident or independent of intercourse [9]. The differential diagnosis for long-lasting erythematous penile lesions is summarized in Table 1 [2, 9, 10].…”

Therapeutic Efficacy of Topical Calcineurin Inhibitors in Plasma Cell Balanitis: Case Series and Review of the Literature

“…Biopsy of the lesion is usually necessary to confirm the diagnosis and rule out other conditions that are considered in the differential diagnosis, such as fixed drug eruptions, seborrheic eczema, lichen planus, lichen sclerosus et atrophicus, cicatricial pemphigoid, penile intraepithelial neoplasia (erythroplasia of Queyrat), squamous cell carcinoma, Kaposi's sarcoma, contact dermatitis or psoriasis [7,16,20,21,22]. Histologically, epidermal edema, a dense upper dermal band of chronic inflammatory cells, including many plasma cells, dilated capillaries, extravasated red blood cells, and hemosiderin deposition, is observed [23].…”

Pimecrolimus 1% Cream in Non-Specific Inflammatory Recurrent Balanitis

“…Histology specimens from such patients have documented perivascular chronic infiltrate in the dermis, often with spongiosis of the epidermis consistent with a diagnosis of non-specific dermatitis [3]. Another study on biopsy specimens obtained from chronic but not recurrent balanitis showed a majority of cases with band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation that do not fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon [8]. Application of emollient creams has been suggested to improve the problem with topical steroids used in cases without response [2, 3].…”