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International Journal of Surgical... Aug 2020Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a...
Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a detailed histopathological description of penile LS, as well as to explore its relationship with penile intraepithelial neoplasia (PeIN) or invasive carcinoma. We evaluated 200 patients and designed a topographical approach for the histological evaluation focusing in alterations of the following anatomical layers: squamous epithelium, lamina propria, dartos, and corpus spongiosum. We documented the quantity and topographical location of stromal lymphocytes. The prevalent lesions found were epithelial hyperplasia, atrophy, PeIN, basal cell vacuolization, lamina propria sclerosis, and variable patterns of lymphocytic infiltration. Various unique patterns of stromal sclerosis were described: perivascular, globular, linear, and solid fibrosis/hyalinization; any of them were found to be diagnostic for LS. The variation in the topography and density of lymphocytes was determinant for the identification of LS morphological variants: lichenoid, band-like, lymphocytic depleted, and mixed. A major finding was the identification of the variant designated as lymphocytic depleted LS, which we considered as the morphological prototype of LS associated with penile neoplasia. The detailed description of this complex lesion presented in this study may help pathologists in practice to identify and better define LS. The identification of the special variants suggests a role of the stromal lymphocytes in the process of carcinogenesis. Confirmation of the observations with more studies is necessary to determine the significance of these findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Balanitis Xerotica Obliterans; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Penile Neoplasms; Precancerous Conditions; Young Adult
PubMed: 31969038
DOI: 10.1177/1066896920901333 -
International Journal of Dermatology May 2021Circumcision is one of the most frequently performed procedure by clinicians, yet its role and indication in clinical practice lacks consensus and remains unclear. We...
BACKGROUND
Circumcision is one of the most frequently performed procedure by clinicians, yet its role and indication in clinical practice lacks consensus and remains unclear. We sought to evaluate a collection of male circumcisions to determine the range of indications, histopathological diagnoses, and type of clinicians associated with circumcision.
METHODS
We performed a retrospective descriptive cohort study of male patients who received a circumcision reported by one major dermatopathology laboratory between January 2017 and December 2018. Data were extracted from the histological report of the pathologist for each case. Patient age, type of clinician, clinical notes, and histopathological diagnosis were evaluated.
RESULTS
"/> A total of 406 circumcisions were identified. The median age for circumcision was 36 (IQR 16-61). Boys less than 18 years of age made up 24% (98/406). Histological diagnoses included normal (43/406, 11%), nonspecific inflammation (82/406, 20%), inflammatory conditions (264/406, 65%), infections (9/406, 2.2%), benign neoplasms (5/406, 1.0%), and scar tissue (3/406, 0.7%). The most common diagnosis was balanitis xerotica obliterans (226/406, 56%). Rarely, genital infections and neoplastic lesions were identified. Circumcisions were performed by urologists (289/406, 71.2%), general practitioners (76/406, 18.7%), general surgeons (32/406, 8%), pediatric surgeons (5/406, 1%), and dermatologists (4/406, 1%). The main indications for circumcision were phimosis (110/202, 54%), suspected lichen sclerosus (28/202, 14%), and balanitis (15/202, 7%).
CONCLUSION
Circumcision was performed for a broad range of genital dermatoses across various medical and surgical specialties. Few studies have described these observations. We discuss the common pathological conditions leading to circumcision and its role in diagnosis and treatment.
Topics: Child; Circumcision, Male; Cohort Studies; Genitalia; Genitalia, Male; Humans; Male; Phimosis; Retrospective Studies; Specialties, Surgical
PubMed: 33319352
DOI: 10.1111/ijd.15359 -
Dermatologic Therapy Nov 2020Ultrapotent topical corticosteroids and circumcision are usually effective for male genital lichen sclerosus (MGLSc); however, refractory cases are often referred to our...
Ultrapotent topical corticosteroids and circumcision are usually effective for male genital lichen sclerosus (MGLSc); however, refractory cases are often referred to our Male Genital Dermatology Unit. Treatment with autologous platelet-rich plasma (TPRP) has recently been advocated as a safe and effective treatment option, but there have been no prospective studies in men to date. The objective of this study is to assess the safety and efficacy of TPRP for MGLSc resistant to conventional therapy. A prospective, open-label, single-arm, therapeutic study was carried out in this study. Inclusion criteria: resistant to conventional therapy for at least 6 months. Procedure: infiltration of 0.1 mL/cm PRP every 8 weeks. Monthly data recording: visual appearance with photographs and external scoring by an expert using Investigator's Global Assessment Scale (IGA scale 0-5), symptoms (scale 0-5), quality of life (QoL; Dermatology Life Quality Index [DLQI]), and complications. No. of patients included was n = 5. No. of patients excluded during treatment was n = 1. Mean initial IGA: 3.6. Mean initial DLQI: 6. TPRP n = 34 (range: 2-9; average: 6.8 per patient). Mean IGA at 18 months: 3.25. Mean DLQI at 18 months: 1.25. All patients reported being completely asymptomatic at 10 months. No. of patients with complications is n = 1 (balanitis). TPRP seems to be safe and effective, regarding symptom control and improvement in QoL; however, visual changes were minimal.
Topics: Circumcision, Male; Humans; Lichen Sclerosus et Atrophicus; Male; Platelet-Rich Plasma; Prospective Studies; Quality of Life
PubMed: 32683770
DOI: 10.1111/dth.14032 -
Surgery Journal (New York, N.Y.) Oct 2020Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. The aim of...
Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. The aim of this study was to report outcomes of therapeutic circumcision from our center. Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services. Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3-16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% ( = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% ( = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% ( = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%. Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.
PubMed: 33335988
DOI: 10.1055/s-0040-1721430 -
BMC Infectious Diseases Mar 2021Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in...
BACKGROUND
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor.
CASE PRESENTATIONS
Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased.
CONCLUSIONS
Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.
Topics: Aged; Benzhydryl Compounds; Candidiasis; Diabetes Mellitus, Type 2; Glucosides; Glycosuria; Humans; Hypoglycemic Agents; Male; Middle Aged; Pharmaceutical Preparations; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 33743624
DOI: 10.1186/s12879-021-05982-3 -
Paediatrics & Child Health Jun 2020Within the paediatric population, changing patterns of circumcisions have confounded the epidemiology and presentation of lichen sclerosus (LS). We sought to evaluate...
Within the paediatric population, changing patterns of circumcisions have confounded the epidemiology and presentation of lichen sclerosus (LS). We sought to evaluate the incidence, demographics, and clinical features of patients presenting to a single Albertan paediatric urologist with LS. This retrospective descriptive analysis evaluated all paediatric patients referred for phimosis to a single paediatric urologist in Edmonton, Alberta. Chief complaints/symptoms, date of birth, and date of circumcision were identified. The primary outcome of interest was the proportion of circumcisions with pathologically confirmed LS. From July 2006 to March 2016, 4,163 patients were seen for phimosis of the approximate 12,000 new referrals. Hundred phimosis patients had clinically suspected LS. Of those adequately reported, 81 (81/83) were microscopically confirmed to be LS with a mean age of 9.6 years and median age of 8.9 years (range 4.1 to 16.1 years). This cohort represented 2.0% of phimosis referrals and approximately 0.7% of all referrals to our paediatric urologist. When compared to physiologic phimosis, these patients had higher rates of dysuria (n=28, 34.6% versus n=1, 1.0%, P<0.0001) and urinary retention (n=18, 22.2% versus n=1, 1.0%, P<0.0001) as presenting complaints. LS of the paediatric male genitalia is an uncommon, albeit clinically significant disease entity. The clinical diagnosis for the trained practitioner is very accurate.
PubMed: 32549740
DOI: 10.1093/pch/pxy172 -
Journal of the American Academy of... Jul 2021Demographic and clinical findings of patients with mucocutaneous morphea have not been well characterized, to our knowledge.
BACKGROUND
Demographic and clinical findings of patients with mucocutaneous morphea have not been well characterized, to our knowledge.
OBJECTIVE
To determine the demographic and clinical characteristics of morphea patients with mucocutaneous lesions who were enrolled in the Morphea in Adults and Children cohort.
METHODS
Cross-sectional study of 735 patients in the Morphea in Adults and Children cohort from 2007 to 2018.
RESULTS
A total of 4.6% of linear morphea patients had oral involvement versus 2.4% among the entire cohort, whereas 10.3% of generalized morphea patients had genital involvement versus 3.7% among the entire cohort. Patients with genital lesions were older at disease onset than those with oral morphea (57 versus 11.5 years; P < .001) and had more frequent extragenital lichen sclerosus et atrophicus (59.2% versus 5.6%; P = .004).
LIMITATIONS
Selection bias and limited number of affected subjects.
CONCLUSION
Oral morphea lesions predominate in younger patients with facial linear morphea, whereas genital lesions predominate in postmenopausal women with overlying extragenital lichen sclerosus et atrophicus.
Topics: Adolescent; Adult; Age Factors; Age of Onset; Balanitis Xerotica Obliterans; Child; Cross-Sectional Studies; Facial Hemiatrophy; Female; Humans; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Prospective Studies; Scleroderma, Localized; Severity of Illness Index; Vulvar Lichen Sclerosus; Young Adult
PubMed: 33249064
DOI: 10.1016/j.jaad.2020.10.093 -
Asian Journal of Surgery Mar 2023
Topics: Male; Humans; Balanitis Xerotica Obliterans
PubMed: 36031515
DOI: 10.1016/j.asjsur.2022.08.045 -
The American Journal of Dermatopathology Nov 2020We describe the association of balanitis xerotica obliterans and differentiated penile intraepithelial neoplasia (PeIN) with dermal elastosis and "bramble-bush" elastic...
Balanitis Xerotica Obliterans Associated With Differentiated Penile Intraepithelial Neoplasia and "Bramble-Bush" Elastic Fibers Accumulation: A Finding Not Specific for Penicillamine Intake.
We describe the association of balanitis xerotica obliterans and differentiated penile intraepithelial neoplasia (PeIN) with dermal elastosis and "bramble-bush" elastic fibers in a diabetic patient with no history of penicillamine intake. An 84-year-old man presented with urethral obstruction syndrome that required postectomy, meatotomy, and foreskin excision. Histopathological examination revealed changes of lichen sclerosus and differentiated PeIN. Orcein staining showed striking dermal elastosis and transepidermal elimination of elastic fibers. At higher magnification, multiple serrations and buds arising from the borders of the elastic fibers were observed giving the so-called bramble-bush appearance. Balanitis xerotica obliterans is considered a premalignant disease, and 14% of patients have evidence of PeIN. The differentiated subtype can be difficult to diagnose because of the minimal basal cell atypia, so a striking dermal elastosis, which may even occur before the neoplasm becomes invasive, may facilitate its diagnosis. The term "acquired perforating dermatosis" seems appropriate to describe those cases of perforating elastosis that occurs in adults with systemic diseases. The bramble-bush appearance of elastic fibers is not specific for penicillamine-induced elastopathy, and it may occur in other diseases, such as diabetes mellitus. This peculiar morphology of elastic fibers may be related to the enzymatic imbalance between matrix metalloproteinases and lysyl oxidase, an enzyme required for the cross-linking of elastic fibers.
Topics: Aged, 80 and over; Balanitis Xerotica Obliterans; Carcinoma in Situ; Diabetes Mellitus, Type 1; Elastic Tissue; Humans; Male; Penicillamine; Penile Neoplasms
PubMed: 32472770
DOI: 10.1097/DAD.0000000000001692 -
Journal of Paediatrics and Child Health Nov 2022Post-circumcision topical steroids may reduce the number of patients with balanitis xerotica obliterans (BXO) who require subsequent meatal dilatation. However, their...
AIM
Post-circumcision topical steroids may reduce the number of patients with balanitis xerotica obliterans (BXO) who require subsequent meatal dilatation. However, their use has only been investigated in the presence of an abnormal urethral meatus. The aim of this study is to determine if post-operative topical steroids reduce the need for subsequent meatal dilatation in patients with histologically proven BXO independent of the appearance of the urethral meatus. To determine if post-operative topical steroids reduce the need for subsequent meatal procedures in patients with histologically proven BXO. To determine if the appearance of the meatus at circumcision affects the need for subsequent meatal procedure.
METHODS
We performed a retrospective review of all paediatric patients with histologically confirmed BXO post circumcision. We excluded all those with 'chronic inflammation' or 'early BXO'. Patients were divided into groups based on whether post-operative topical steroids were prescribed. The appearance of the urethral meatus at circumcision was recorded. Primary outcome was progression to subsequent meatal dilatation. Statistical significance was calculated using Fisher's exact test. A P value < 0.05 was considered significant.
RESULTS
One hundred and seventeen patients with histologically confirmed BXO were identified between October 2012 and December 2017. Fifty-nine patients were prescribed post-operative topical steroids (50%). Nine patients required subsequent meatal dilatation procedure (8%) and only one of these had been prescribed post-operative topical steroids (P = 0.0165). Abnormal meatus was noted in 24 (21%) patients. Three patients in this group required subsequent meatal dilatation compared with 6 in the group with a normal meatal appearance (P = 0.385).
CONCLUSIONS
Post-operative topical steroids can reduce the need for subsequent meatal dilatation in boys with BXO. The appearance of the urethral meatus at circumcision does not predict the need for subsequent meatal dilatation.
Topics: Male; Child; Humans; Balanitis Xerotica Obliterans; Dilatation; Circumcision, Male; Retrospective Studies; Steroids
PubMed: 35932250
DOI: 10.1111/jpc.16145