Case and Research Letters
Tuberous Lesion of the Penis
Lesión tuberosa en el pene
L. Miguel-Gómez
, S. Pérez-Gala, P. Jaén-Olasolo
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 6 | 18 |
| 2024 Octubre | 76 | 43 | 119 |
| 2024 Septiembre | 64 | 28 | 92 |
| 2024 Agosto | 96 | 68 | 164 |
| 2024 Julio | 64 | 39 | 103 |
| 2024 Junio | 75 | 36 | 111 |
| 2024 Mayo | 67 | 37 | 104 |
| 2024 Abril | 77 | 32 | 109 |
| 2024 Marzo | 73 | 32 | 105 |
| 2024 Febrero | 69 | 36 | 105 |
| 2024 Enero | 53 | 32 | 85 |
| 2023 Diciembre | 51 | 17 | 68 |
| 2023 Noviembre | 66 | 23 | 89 |
| 2023 Octubre | 48 | 22 | 70 |
| 2023 Septiembre | 51 | 31 | 82 |
| 2023 Agosto | 39 | 13 | 52 |
| 2023 Julio | 46 | 33 | 79 |
| 2023 Junio | 34 | 20 | 54 |
| 2023 Mayo | 41 | 25 | 66 |
| 2023 Abril | 44 | 25 | 69 |
| 2023 Marzo | 47 | 35 | 82 |
| 2023 Febrero | 30 | 19 | 49 |
| 2023 Enero | 34 | 25 | 59 |
| 2022 Diciembre | 47 | 43 | 90 |
| 2022 Noviembre | 27 | 21 | 48 |
| 2022 Octubre | 23 | 22 | 45 |
| 2022 Septiembre | 24 | 35 | 59 |
| 2022 Agosto | 23 | 32 | 55 |
| 2022 Julio | 18 | 33 | 51 |
| 2022 Junio | 25 | 22 | 47 |
| 2022 Mayo | 25 | 42 | 67 |
| 2022 Abril | 38 | 37 | 75 |
| 2022 Marzo | 37 | 43 | 80 |
| 2022 Febrero | 20 | 14 | 34 |
| 2022 Enero | 33 | 31 | 64 |
| 2021 Diciembre | 32 | 34 | 66 |
| 2021 Noviembre | 35 | 39 | 74 |
| 2021 Octubre | 44 | 45 | 89 |
| 2021 Septiembre | 28 | 36 | 64 |
| 2021 Agosto | 33 | 26 | 59 |
| 2021 Julio | 33 | 37 | 70 |
| 2021 Junio | 33 | 34 | 67 |
| 2021 Mayo | 32 | 28 | 60 |
| 2021 Abril | 81 | 32 | 113 |
| 2021 Marzo | 67 | 30 | 97 |
| 2021 Febrero | 80 | 25 | 105 |
| 2021 Enero | 40 | 14 | 54 |
| 2020 Diciembre | 34 | 21 | 55 |
| 2020 Noviembre | 19 | 23 | 42 |
| 2020 Octubre | 21 | 3 | 24 |
| 2020 Septiembre | 30 | 19 | 49 |
| 2020 Agosto | 23 | 12 | 35 |
| 2020 Julio | 24 | 14 | 38 |
| 2020 Junio | 29 | 32 | 61 |
| 2020 Mayo | 22 | 13 | 35 |
| 2020 Abril | 29 | 17 | 46 |
| 2020 Marzo | 29 | 13 | 42 |
| 2020 Febrero | 9 | 1 | 10 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 8 | 2 | 10 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 12 | 3 | 15 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 2 | 3 | 5 |
| 2019 Junio | 5 | 6 | 11 |
| 2019 Mayo | 3 | 29 | 32 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 10 | 0 | 10 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Febrero | 58 | 3 | 61 |
| 2018 Enero | 20 | 4 | 24 |
| 2017 Diciembre | 59 | 6 | 65 |
| 2017 Noviembre | 23 | 2 | 25 |
| 2017 Octubre | 24 | 5 | 29 |
| 2017 Septiembre | 12 | 7 | 19 |
| 2017 Agosto | 22 | 6 | 28 |
| 2017 Julio | 17 | 8 | 25 |
| 2017 Junio | 26 | 9 | 35 |
| 2017 Mayo | 30 | 9 | 39 |
| 2017 Abril | 13 | 6 | 19 |
| 2017 Marzo | 16 | 7 | 23 |
| 2017 Febrero | 9 | 10 | 19 |
| 2017 Enero | 12 | 9 | 21 |
| 2016 Diciembre | 25 | 25 | 50 |
| 2016 Noviembre | 23 | 15 | 38 |
| 2016 Octubre | 11 | 14 | 25 |
| 2016 Septiembre | 0 | 3 | 3 |
| 2016 Julio | 0 | 1 | 1 |
| 2016 Junio | 4 | 1 | 5 |
| 2016 Abril | 1 | 10 | 11 |
| 2016 Marzo | 1 | 4 | 5 |
| 2016 Febrero | 0 | 3 | 3 |
| 2016 Enero | 0 | 2 | 2 |
| 2015 Noviembre | 0 | 1 | 1 |
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