Case and Research Letters
Tuberous Lesion of the Penis
Lesión tuberosa en el pene
L. Miguel-Gómez
, S. Pérez-Gala, P. Jaén-Olasolo
Corresponding author
Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
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Miguel-Gómez, S. Pérez-Gala, P. Jaén-Olasolo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Miguel-Gómez" "email" => array:1 [ 0 => "lmg_0007@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Pérez-Gala" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Jaén-Olasolo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión tuberosa en el pene" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 268580 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intranuclear human herpes virus 8 (HVV-8) expression (immunohistochemical HHV-8 stain, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 48-year-old heterosexual man who presented with a tuberous lesion of 1 month's duration on the penis. His personal history was remarkable for pulmonary tuberculosis 6 years earlier and an episode of herpes zoster with trigeminal nerve involvement 3 years earlier. The only symptom reported was occasional bleeding. He was not on immunosuppressant therapy and he denied sexual risk behavior and intravenous drug use. He had no past history of sexually transmitted disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a pink, round, pedunculated tumor with a soft consistency located in the balanopreputial sulcus. Of note was a hyperkeratotic component on the surface of the tumor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The locoregional lymph nodes were not enlarged and there were no signs of oral mucosal involvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The histology study showed a proliferation of atypical spindle cells with an elongated nucleus, well-defined cytoplasm, and increased mitotic activity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry showed CD31 positivity and intranuclear staining for human herpesvirus 8 (HHV-8) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). All these findings were consistent with a diagnosis of classic Kaposi sarcoma on the penis of a middle-aged, immunocompetent patient. Additional testing included blood tests with complete blood count, biochemistry, antinuclear antibodies, tumor markers, lymphocyte counts (B cells/type 1 helper (T<span class="elsevierStyleInf">H</span>1) T cells/T<span class="elsevierStyleInf">H</span>2 cells/natural killer [NK] cells), smears, β<span class="elsevierStyleInf">2</span>-microglobulin levels, immunoglobulin counts, and viral serology tests (human immunodeficiency virus [HIV] 1, HIV-2, viral hepatitis A [VHA], VHC, VHB, HHV-6, HHV-7, HHV-8, Epstein-Barr virus, cytomegalovirus, human T-cell lymphotropic virus [HTLV] 1, HTLV-2, and varicella-zoster virus). All the results were normal, except for HHV-8 serology, which was positive. Computed tomography of the chest, abdomen, and pelvis showed no additional significant findings. The presence of an immunodeficiency disorder was ruled out in the immunology department.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The tumor was excised with disease-free margins, and the patient has not experienced any local recurrences or developed new lesions on other areas of the skin in 9 months of follow-up.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Kaposi sarcoma tumors are derived from endothelial cells. They follow a variable clinical course, ranging from minimal mucocutaneous involvement to systemic disease involving the internal organs. Disease progression varies according to the patient's origin, age, sex, and immune status. Four types of Kaposi sarcoma have been described: classic, endemic, iatrogenic, and HIV-related. Classic Kaposi sarcoma is typically more common in the Mediterranean region and Eastern Europe, and affects patients aged between 50 and 70 years. It occurs in both men and women, with reported male to female ratios ranging from 3:1 to 10:1, depending on the series. Skin lesions in classic Kaposi sarcoma are typically seen on the lower limbs, and penile involvement is very rare. Penile lesions are estimated to be the first manifestation of Kaposi sarcoma in 2% to 3% of patients with HIV infection and they are usually associated with a more aggressive course in this population.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> By contrast, according to reports in the English-language literature, just 15 cases of Kaposi sarcoma confined to the penis have been reported in HIV-negative patients in the past 20 years.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> In cases similar to ours (young patient with a history of a mycobacterial and herpes infection and classic Kaposi sarcoma), it is important to test T-cell (T<span class="elsevierStyleInf">H</span>1, T<span class="elsevierStyleInf">H</span>2), B-cell, NK-cell, and immunoglobulin levels to rule out a primary immunodeficiency disorder.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> To investigate the presence of secondary or acquired immunodeficiency, viral serology tests including HIV, HHV-8, HTLV-1 and 2, and Epstein-Barr virus, among others, should be performed, in addition to blood smears and tumor marker and antinuclear antibody tests.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis should include pyogenic granuloma, molluscum contagiosum, genital warts, and Bowenoid papulosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Bacillary angiomatosis should also be investigated in patients with multiple lesions. Local surgical excision is indicated in cases like ours that involve small, solitary lesions. Good results have also been described for intralesional vinblastine, cryotherapy, electrocoagulation, laser therapy, radiation therapy, intralesional interferon alfa and beta, photodynamic therapy, nitrogen mustards, and imiquimod. Chemotherapy and radiation therapy tend to be reserved for cases involving extensive lesions or internal organ involvement.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Miguel-Gómez L, Pérez-Gala S, Jaén-Olasolo P. Lesión tuberosa en el pene. Actas Dermosifiliogr. 2015;106:680–681.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 975 "Tamanyo" => 107751 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pink pedunculated tumor with a keratotic surface in the balanopreputial sulcus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 397520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Proliferation of atypical spindle cells with an elongated nucleus, well-defined cytoplasm, and increased mitotic activity (hematoxylin-eosin, original magnification ×20).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 268580 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intranuclear human herpes virus 8 (HVV-8) expression (immunohistochemical HHV-8 stain, original magnification ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary classic Kaposi's sarcoma of the penis in an HIV-negative patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 6 | 16 |
| 2024 October | 76 | 43 | 119 |
| 2024 September | 64 | 28 | 92 |
| 2024 August | 96 | 68 | 164 |
| 2024 July | 64 | 39 | 103 |
| 2024 June | 75 | 36 | 111 |
| 2024 May | 67 | 37 | 104 |
| 2024 April | 77 | 32 | 109 |
| 2024 March | 73 | 32 | 105 |
| 2024 February | 69 | 36 | 105 |
| 2024 January | 53 | 32 | 85 |
| 2023 December | 51 | 17 | 68 |
| 2023 November | 66 | 23 | 89 |
| 2023 October | 48 | 22 | 70 |
| 2023 September | 51 | 31 | 82 |
| 2023 August | 39 | 13 | 52 |
| 2023 July | 46 | 33 | 79 |
| 2023 June | 34 | 20 | 54 |
| 2023 May | 41 | 25 | 66 |
| 2023 April | 44 | 25 | 69 |
| 2023 March | 47 | 35 | 82 |
| 2023 February | 30 | 19 | 49 |
| 2023 January | 34 | 25 | 59 |
| 2022 December | 47 | 43 | 90 |
| 2022 November | 27 | 21 | 48 |
| 2022 October | 23 | 22 | 45 |
| 2022 September | 24 | 35 | 59 |
| 2022 August | 23 | 32 | 55 |
| 2022 July | 18 | 33 | 51 |
| 2022 June | 25 | 22 | 47 |
| 2022 May | 25 | 42 | 67 |
| 2022 April | 38 | 37 | 75 |
| 2022 March | 37 | 43 | 80 |
| 2022 February | 20 | 14 | 34 |
| 2022 January | 33 | 31 | 64 |
| 2021 December | 32 | 34 | 66 |
| 2021 November | 35 | 39 | 74 |
| 2021 October | 44 | 45 | 89 |
| 2021 September | 28 | 36 | 64 |
| 2021 August | 33 | 26 | 59 |
| 2021 July | 33 | 37 | 70 |
| 2021 June | 33 | 34 | 67 |
| 2021 May | 32 | 28 | 60 |
| 2021 April | 81 | 32 | 113 |
| 2021 March | 67 | 30 | 97 |
| 2021 February | 80 | 25 | 105 |
| 2021 January | 40 | 14 | 54 |
| 2020 December | 34 | 21 | 55 |
| 2020 November | 19 | 23 | 42 |
| 2020 October | 21 | 3 | 24 |
| 2020 September | 30 | 19 | 49 |
| 2020 August | 23 | 12 | 35 |
| 2020 July | 24 | 14 | 38 |
| 2020 June | 29 | 32 | 61 |
| 2020 May | 22 | 13 | 35 |
| 2020 April | 29 | 17 | 46 |
| 2020 March | 29 | 13 | 42 |
| 2020 February | 9 | 1 | 10 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 12 | 3 | 15 |
| 2019 August | 4 | 1 | 5 |
| 2019 July | 2 | 3 | 5 |
| 2019 June | 5 | 6 | 11 |
| 2019 May | 3 | 29 | 32 |
| 2019 March | 2 | 3 | 5 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 10 | 0 | 10 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 5 | 0 | 5 |
| 2018 February | 58 | 3 | 61 |
| 2018 January | 20 | 4 | 24 |
| 2017 December | 59 | 6 | 65 |
| 2017 November | 23 | 2 | 25 |
| 2017 October | 24 | 5 | 29 |
| 2017 September | 12 | 7 | 19 |
| 2017 August | 22 | 6 | 28 |
| 2017 July | 17 | 8 | 25 |
| 2017 June | 26 | 9 | 35 |
| 2017 May | 30 | 9 | 39 |
| 2017 April | 13 | 6 | 19 |
| 2017 March | 16 | 7 | 23 |
| 2017 February | 9 | 10 | 19 |
| 2017 January | 12 | 9 | 21 |
| 2016 December | 25 | 25 | 50 |
| 2016 November | 23 | 15 | 38 |
| 2016 October | 11 | 14 | 25 |
| 2016 September | 0 | 3 | 3 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 4 | 1 | 5 |
| 2016 April | 1 | 10 | 11 |
| 2016 March | 1 | 4 | 5 |
| 2016 February | 0 | 3 | 3 |
| 2016 January | 0 | 2 | 2 |
| 2015 November | 0 | 1 | 1 |
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