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June 20, 2011

Erythematous Shiny Plaque Over the Glans Penis—Diagnosis

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Arch Dermatol. 2011;147(6):735-740. doi:10.1001/archdermatol.2011.129-b

Histopathologic analysis revealed mucosa with an absent keratin layer, a smooth epithelial base, and superficial keratinocyte detachment and degeneration. There was some reactive epithelial atypia but no dysplasia. In most areas, the epithelial surface had been replaced by columnar cells with foamy cytoplasm containing pale staining mucin. Nuclei were small, monomorphic, rounded, and basally sited. Sparse cells were seen lower in the epithelium, but there was no pagetoid scatter. The mucin stained strongly positive with periodic acid–Schiff and Alcian blue stains. Immunohistochemical analysis showed strong cytoplasmic staining for epithelial markers CK7, 34betaE12, CAM 5.2, and CEA and membranous staining for EMA but none for Ber-EP4. The subepithelial tissue showed a dense chronic inflammatory cell infiltrate dominated by plasma cells with sparse eosinophils, consistent with Zoon balanitis.