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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 2  |  Page : 208
Bluish-coloured papule over the penile shaft


1 From the Department of Dermatology, AIIMS, Jodhpur, Rajasthan, India
2 Past Affiliation: Senior Resident, Department of Dermatology, AIIMS, Jodhpur, Rajasthan; Present Affiliation: Assistant Professor, Department of Dermatology, AIIMS, Rajkot, Gujarat, India
3 From the Department of Pathology, AIIMS, Jodhpur, Rajasthan, India

Date of Web Publication13-Jul-2022

Correspondence Address:
Anupama Bains
From the Department of Dermatology, AIIMS, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_1073_21

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How to cite this article:
Bains A, Alam A, Pathania YS, Vishwajeet V. Bluish-coloured papule over the penile shaft. Indian J Dermatol 2022;67:208

How to cite this URL:
Bains A, Alam A, Pathania YS, Vishwajeet V. Bluish-coloured papule over the penile shaft. Indian J Dermatol [serial online] 2022 [cited 2022 Aug 17];67:208. Available from: https://www.e-ijd.org/text.asp?2022/67/2/208/350829




Sir,

A 16-year-old male presented with an asymptomatic bluish-coloured papule over the shaft of the penis for 8 months. There was no history of bleeding from the lesion. There was no previous history of trauma, infection, surgery, and fever. His sexual history and family history were non-significant. On examination, there was a solitary round-shaped bluish-coloured papule with a smooth surface [Figure 1]. Along with this, there were a few tiny skin-coloured grouped papules over the shaft of the penis. His pelvic ultrasonography was normal. Skin biopsy from the lesion showed hyperkeratotic and acanthotic epidermis. The dermis showed numerous ectatic dilated vascular channels [Figure 2]a which showed negative staining for CD34 [Figure 2]b and focal strong positivity for D2-40 [Figure 2]c. Based on these findings, diagnoses of penile lymphangiomas were made.
Figure 1: Solitary round-shaped bluish-coloured papule with a smooth surface and a few skin-coloured grouped papules over the shaft of the penis

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Figure 2: (a) Subepithelial tissue contains dilated vascular channels lined by flattened epithelial cells. Also, note fibrin and lymphocytic cell collection (hematoxylin and eosin, ×100). (b and c) These vascular channels show negative staining for CD34 (internal control positive, b, X400) but show focal strong positivity for D2-40 (c, ×1000)

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Lymphangiomas are benign malformations of the lymphatic system.[1] They can be congenital or acquired.[2] Congenital lymphangiomas occur because of failure of foetal lymph vessels to involute or join with the central lymphatic system.[1] Acquired lymphangiomas usually develop in the areas of skin affected by obstruction or destruction of lymphatic drainage.[3] Various causes of acquired lymphangiomas are trauma, bacterial infections of lymphatic channels (cellulitis), tuberculosis, filariasis, lymphogranuloma venerum, malignancy, radiotherapy, pregnancy, and so forth.[1],[2],[4] However, in the present case, lesions appeared spontaneously.

Clinically, lymphangiomas present as crops of papulovesicular lesions filled with a clear or serosanguinous fluid resembling frogspawn. It can be blue-black in colour because of the accumulation of blood. It may be associated with intermittent swelling, leakage of clear or bloody lymph, and secondary bacterial infections. With a chronic course, lesions may develop a warty surface.[5] The common sites of involvement are the trunk, axilla, thigh, gluteal area, and oral cavity.[4] However the penis is an uncommon site, and the lesions may be present on the shaft or coronal sulcus of the penis.[1] Rarely, they can present as solitary lesions.[4],[5] Histopathologically, lymphangioma circumscriptum (LC) is characterised by dilated lymph spaces in the upper dermis and the subcutis. The lumen is filled with the lymphatic fluid and may contain red blood cells and a few inflammatory cells.[2]

These lesions can be confused with genital warts and molluscum.[1] Other differentials that were considered in the present case were angiokeratoma of Fordyce and pyogenic granuloma. Angiokeratoma of Fordyce commonly involves the scrotum and can be present on the shaft of the penis. It presents as multiple discrete bluish keratotic papules which easily bleed. Histopathologically, they are characterised by dermal vascular ectasia with overlying hyperkeratosis of the epidermis.[6] Pyogenic granuloma or lobular capillary haemangioma is a benign vascular tumour of the skin or mucous membranes characterised by rapid growth. It commonly presents over extremities as solitary friable erythematous papules with the bleeding surface.

Usually, no treatment is required if lesions of penile lymphangiomas are small and asymptomatic. However, the patient can be treated if there is a cosmetic concern and to prevent recurrent infections, especially in larger lesions. Various therapeutic modalities are surgical destruction, laser ablation, electrocautery, cryotherapy, sclerotherapy, and so forth.[2] In our patient, radiofrequency ablation was performed. Recognition and awareness of penile lymphangiomas are important to alleviate the fear of having a sexually transmitted disease in a patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Macki M, Anand SK, Jaratli H, Dabaja AA. Penile lymphangioma: Review of the literature with a case presentation. Basic Clin Androl 2019;29:1.  Back to cited text no. 1
    
2.
Kokcam I. Lymphangioma circumscriptum of the penis: A case report. Acta Dermatovenerol Alp Pannonica Adriat 2007;16:81-2.  Back to cited text no. 2
    
3.
Gupta S, Radotra BD, Javaheri SM, Kumar B. Lymphangioma circumscriptum of the penis mimicking venereal lesions. J Eur Acad Dermatol Venereol 2003;17:598-600.  Back to cited text no. 3
    
4.
Adikari S, Philippidou M, Samuel M. A rare case of acquired lymphangioma circumscriptum of the penis. Int J STD AIDS 2017;28:205-7.  Back to cited text no. 4
    
5.
Daklan S, Daryakar A. Lymphangioma circumscriptum of glans penis: A report of two cases. Dermatol Online J 2018;24:13030/qt9pr342qv.  Back to cited text no. 5
    
6.
Pahwa P, Meena D, Tanveer N, Sharma VK, Sethuraman G. Punctate vascular papules on the tongue and scrotum. Indian J Dermatol 2012;57:228-9.  Back to cited text no. 6
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