Penis and scrotum
Inflammatory lesions
Lichen sclerosus (balanitis xerotica obliterans)

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 30 March 2018, last major update February 2010

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: (Lichen sclerosus OR balanitis xerotica obliterans) penis[TI]

Cite this page: Cubilla, A., Chaux, A. Lichen sclerosus (balanitis xerotica obliterans). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumbxo.html. Accessed August 16th, 2018.
Terminology
  • Also called lichen sclerosus et atrophicus
  • Balanitis: inflammation of glans, from Greek ("acorn")
  • Xerotica: unable to determine origin of term but used by Stuhmer in 1928 (see also Arch Dermatol Syph 1941;44:547)
Epidemiology
Sites
  • More frequent in inner foreskin but coronal sulcus, glans and even urethra may be affected
Etiology
Clinical features
  • Most common cause of pathological phimosis in boys
  • May also cause narrowing of urethral meatus and paraphimosis
  • Associated with low grade keratinizing squamous cell carcinoma (non HPV variants - squamous cell, NOS, pseudohyperplastic, verrucous and papillary, Am J Surg Pathol 2003;27:1448) in glans and foreskin
  • Usually not associated with basaloid or warty carcinoma
  • Atypical lichen sclerosus shows epithelial dysplastic changes (low grade or high grade)
Prognostic factors
Recommendations for followup to rule out carcinoma include:
Case reports
Treatment
  • Circumcision but may recur at scar
Clinical images

Images hosted on PathOut server:

AFIP images:

Fig 10-80: perimeatal
glans is pearly white
(Atlas of genitourinary
tract disorders 1988)



Images hosted on other servers:

Lichen sclerosus

University of Alabama

Gross description
  • Gray-white irregular geographic foci of atrophy in inner foreskin, glans or perimeatal area
  • Erosion, ulceration and raised pearly white areas can also be seen
  • In advanced cases, inner preputial folds may disappear due to replacement of elastic fibers by fibrous tissue
Microscopic (histologic) description
  • Thinning or thickening of epidermis with orthokeratotic (i.e. anuclear as in normal epidermis) hyperkeratosis, lamina propria thickening and loss of structures due to edema, sclerosis or hyalinization
  • Vacuolar degeneration of basal layer, diffuse fibrosis and deep lymphocytic infiltrate
  • Usually spares corpus spongiosum of glans and foreskin dartos
  • Atypical cases have epithelial changes of penile intraepithelial neoplasia (PeIN), usually differentiated
Microscopic (histologic) images

Images hosted on PathOut server:

AFIP images:

10-80B: band-like sub-
epithelial zone of dense
fibrosis spares the
corpus spongiosum

10-80C: lamina
propria is
edematous to
focally hyalinized


Contributed by Alcides Chaux, M.D. and Antonio Cubilla, M.D.

Atypical lichen sclerosus:
differentiated penile intraepithelial
neoplasia associated with underlying
lichen sclerosus (left bottom field)



Case of the Week #320:

Various images



Images hosted on other servers:

Hyperkeratosis of prepuce

Subepithelial fibrosis

Orthokeratotic hyperkeratosis

Hyalinized lamina propria