Christodoulidou Michelle, Bunker Christopher B, Trevisan Giorgia, Muneer Asif
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Case Rep. 2016 Aug 24;2016:bcr2016216913. doi: 10.1136/bcr-2016-216913.
We describe the case of a 73-year-old man who presented with a 10-month history of an ulcerating lesion on the glans penis. Initially this was thought to be an invasive squamous cell carcinoma but a biopsy showed histological features consistent with necrotizing granulomatous inflammation. Extensive serological, immunological and microbiological tests only showed a positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies indicating a possible autoimmune aetiology but an underlying systemic cause was not identified. Treatment with oral corticosteroids limited the inflammatory process but due to the gross destruction of the glans penis, he still required a glansectomy and split-skin graft reconstruction from which he recovered well. Although this patient ultimately required surgery for this rare presentation, this case highlights the differential diagnosis of penile ulceration (that transcends neoplasia) and the importance of performing and interpreting penile biopsies before undertaking potentially mutilating definitive surgery.
我们描述了一名73岁男性的病例，他阴茎头出现溃疡性病变已有10个月。最初认为这是侵袭性鳞状细胞癌，但活检显示组织学特征符合坏死性肉芽肿性炎症。广泛的血清学、免疫学和微生物学检查仅显示抗核抗体和抗中性粒细胞胞浆周缘抗体呈阳性，提示可能存在自身免疫病因，但未发现潜在的全身性病因。口服糖皮质激素治疗限制了炎症过程，但由于阴茎头严重毁损，他仍需要进行阴茎头切除术和中厚皮片移植重建术，术后恢复良好。尽管该患者最终因这种罕见表现需要手术治疗，但该病例突出了阴茎溃疡的鉴别诊断（超越肿瘤）以及在进行可能造成毁伤的确定性手术前进行阴茎活检并解读其结果的重要性。
