Penis

Question 1

White to red wrinkled plaques with hypopigmentation (tissue paper like)
That affects foreskin, glans and perimeatal region. There is atrophy of overlying epithelium with band-like lymphocytic infiltrate beneath homogenized collagen
Dx?
Prognosis?
Association?

Answer 1

Lichen sclerosus
Increased risk for differentiated penile intraepithelial neoplasia (PeIN)
Some progress to SCCA
Associated with autoimmune conditions

Question 2

Red shiny plaque corresponding to accumulation of plasma cells with lichenoid inflammation of the dermjs. It affects uncircumcised men

Answer 2

Plasma cell balanitis (Zoon balanitis)

Question 3

Red plaque with sharp borders with intraepithelial proliferation of apocrine-like cells in groups or singly and can extend down adnexal structures.
Dx?
Prognosis?
Ihc?

Answer 3

Extramammary pagets disease
Can progress to invasive adenocarcinoma
IHC : (+) CK7, GCDFP15, CEA, HER2, GATA3

Question 4

A 70 year old HIV patient came in due to penile plaque. Dx was conventional SCCA, keratinizing.
What is the most likely precursor lesion and predisposing favtor?

Answer 4

1-25% are assoc with HPV infection (undifferentiated PeIN as precursor lesion) - usually HPV 16

Differentiated PeIN (HPV-independent) - assoc with balanitis xerotica obliterans

Question 5

What are the two distinct undifferentiated PeIN lesions?
Differentiate

Answer 5

Bowen disease - in older men, not multiple, 10% give rise to infiltrating SCCA

Bowenoid papulosis- in sexually active adults, multiple, virtually never develops into invasive carcinoma