Penile Pseudoepitheliomatous Hyperplasia

A 76-year-old man reported a 3-month history of an asymptomatic, raised, reddened lesion on his penis. The patient had type 2 diabetes mellitus. In 1994, a basal cell carcinoma had been excised from his chest and, 3 years later, a squamous cell carcinoma was excised from his left temple.

The penile lesion was approximately 3 cm in diameter and located at the anterior distal prepuce. The lesion was excised under local anesthesia; healing was without complication.

Drs Robert P. Blereau, MD of Morgan City, La, and J. P. Pecot of New Iberia, La, report that the microscopic examination showed pseudoepitheliomatous hyperplasia with underlying marked acute/subacute and chronic inflammation extending into the deeper dermis with microabscesses, small hemorrhagic areas, and fibrosis. Acid-fast stain demonstrated no organisms; Gomori's methenamine silver stain and periodic acid-Schiff stain disclosed no fungi. Stains for other bacterial and pathogenic organisms also were unrevealing.

Several pathology consultations were obtained, but the exact cause of this lesion remains undetermined. However, there is consensus that the lesion appeared to be a granulocytic dermatitis consistent with such disorders as Sweet's syndrome; Wells' syndrome, or eosinophilic cellulitis; pyoderma gangrenosum; and bacterial pyoderma.