Author(s): Shah M., Maleki N., Edward S.
Abstract: Background: Zoon's or plasma cell balanitis is an idiopathic inflammatory dermatosis affecting the glans penis and foreskin. The nonspecific histologic finding of plasma cells in biopsy specimens from penile lesions may lead pathologists and clinicians into a false sense of security. This may result in a failure to look for subtle histologic signs of another underlying condition and the failure to consider other important clinical diagnoses. Methods: A retrospective study of 23 cases labelled as Zoon's balanitis or plasma cell balanitis taken from the histopathology database. Slides were reviewed by two pathologists and were assessed for the classical features of the condition, plus other histologic features that have been described in studies of Zoon's balanitis. Results: The average age of the patients was 56.3 years. The histologic features between cases were highly variable. Four cases were diagnosed as Zoon's despite the complete absence of epidermis. In the epidermis, the following histologic features were noted in specimens: lozenge keratinocytes (78%), acanthosis (48%), spongiosis (56%), lichenoid infiltrate of lymphocytes (43%), basal cell hydropic degeneration (43%), superficial erosions (30%), neutrophilic infiltrate (26%), atrophy (26%) and parakeratosis (9%). There was no dysplasia. In the dermis, histologic features were: vascular proliferation (87%), dense plasma cell infiltrate (83%), vertical orientation of dermal vessels (69%), hemosiderin deposition (17%), erythrocyte extravasation (13%) and fibrosis (4%). There was no homogenization of collagen or atypical cells. Conclusions: There were a variety of histopathologic features in the 23 patients surveyed, suggesting Zoon's does not delineate a single condition. In some cases, the features were masking another underlying inflammatory disorder. Zoon's balanitis is a term used loosely by pathologists to describe a number of similar pathologic features, usually (but not always) with a dense plasmacytic infiltrate, but should be regarded as a nonspecific reactive pattern and not as a distinct clinical and histopathologic diagnosis. Clinicians and pathologists should look hard to exclude other underlying dermatoses and dysplasia. The term Zoon's balanitis may now be outdated as this entity seems to be a nonspecific inflammatory disorder.
Publication Type: Journal: Conference Abstract