云母状角化性假上皮瘤样龟头炎五例分析

目的 探讨云母状角化性假上皮瘤样龟头炎（PKMB）的临床及病理学特征。 方法 分析2008年1月至2013年12月收集的5例PKMB患者的临床、病理特点以及治疗经过。 结果 5例患者发病年龄56 ~ 67岁，均未行包皮切除术。龟头及包皮内板见硬化性角化性斑块，表面覆灰黄色云母状痂皮，结痂均难以剥脱、质地硬，无触痛。病理检查显示显著的角化过度伴角化不全；表皮呈假上皮瘤样增生，棘层肥厚，细胞排列极性正常；真皮上层毛细血管扩张，轻至中度淋巴细胞浸润。免疫组化显示，2例患者人乳头状瘤病毒（HPV）表皮细胞核阳性。2例患者口服小剂量泼尼松，疗效欠佳；2例口服异维A酸，曾有较好疗效，但减量后复发；改外用糖皮质激素软膏、他克莫司软膏或予CO2激光及光动力治疗，厚痂仍出现。 结论 PKMB发病过程呈慢性、顽固性，诊断需结合病理。本病治疗困难，维A酸治疗有一定效果，但停药容易复发，需维持治疗。

Clinical analysis of pseudoepitheliomatous keratotic and micaceous balanitis: five case reports

Zhu Huiling*, Zhong Minhua, Zhang Xinyue, Ma Chunguang, Ke Zunfu, Liao Qiman, Han Jiande. *Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China Corresponding author: Han Jiande, Email: hanjd-gzb@21cn.net 【Abstract】 Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis （PKMB）. Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from January 2008 to December 2013. Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients, and none of the patients had received prepucectomy. Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation, whose surfaces were covered with grayish yellow, adherent and hard micaceous crusts. Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis, epidermal pseudoepitheliomatous hyperplasia, thickened spinous layer, and normal cell polarity in the epidermis, as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis. Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus （HPV） in 2 cases. Two patients took small doses of prednisone, but achieved no obvious improvement. Oral isotretinoin had resulted in a favorable outcome in another two cases, but relapse occurred after dose reduction, and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream, or carbon dioxide laser treatment and photodynamic therapy. Conclusions PKMB is a chronic and obstinate disease, and should be diagnosed based on pathological findings. Its treatment is difficult, and tretinoin has some effects, but relapse often occurs after drug withdrawal and maintenance treatment is needed.