Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 13;11(7):1986.
doi: 10.3390/biomedicines11071986.

Immunohistological Analysis of Lichen Sclerosus of the Foreskin in Pediatric Age: Could It Be Considered a Premalignant Lesion?

Salvatore Arena  1 , Antonio Ieni  2 , Monica Currò  3 , Mario Vaccaro  4 , Donatella Di Fabrizio  1 , Fabiola Cassaro  1 , Roberta Bonfiglio  1 , Angela Simona Montalto  1 , Giovanni Tuccari  1 , Angela Alibrandi  5 , Pietro Impellizzeri  1 , Carmelo Romeo  1
Affiliations

Immunohistological Analysis of Lichen Sclerosus of the Foreskin in Pediatric Age: Could It Be Considered a Premalignant Lesion?

Salvatore Arena et al. Biomedicines. .

Abstract

Background: A major worry of juvenile penile LS is potential malignant degeneration to spinocellular carcinoma (SCC) in adulthood. LS is characterized by increased CD8+ and CD57+ cells, dermal sclerosis, epidermal atrophy, and hyperkeratosis. p53 and Ki67 are reliable premalignant markers. Our aim was to define the LS immunohistochemical profile of foreskin in children, focusing on tissue immune response and cell proliferation.

Methods: Thirty specimens of foreskins removed from pediatric patients during circumcision were included: six from ritual operation (A), twelve from phimosis (B), and twelve from phimosis with LS (C). Formalin-fixed paraffin-embedded sections were stained for histomorphology and immunohistochemistry. A quantitative evaluation for CD8, CD57, p53, and Ki-67 and a statistical analysis were performed.

Results: As compared to groups A and B, the samples from group C patients showed an acanthotic epidermis, a dermal band of lymphoid infiltrate with a significant enhancement of CD8+ CD57+ lymphocytes, and a keratinocytic hyperplasia with an overexpression of Ki67+ and p53+ cells.

Conclusions: Immunohistological findings confirmed an immune reaction and proliferative behavior in juvenile LS of foreskin. We believe that radical circumcision should be the first treatment of choice in pediatric patients with clinical suspicious of LS for the potential risk of transformation to SCC in adulthood.

Keywords: children; foreskin; immunohistology; lichen sclerosus; spinocellular carcinoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Histomorphology and immunohistochemistry of foreskin cells from ritual circumcisions. (a) Histomorphology of foreskin from ritual circumcision. (b) Immunohistochemical evaluation of CD8+-positive cells. (c) Immunohistochemical evaluation of CD57+-positive cells. (d) Immunohistochemical evaluation of Ki-67-positive cells. (e) Immunohistochemical evaluation of p53-positive cells.
Figure 1
Figure 1
Histomorphology and immunohistochemistry of foreskin cells from ritual circumcisions. (a) Histomorphology of foreskin from ritual circumcision. (b) Immunohistochemical evaluation of CD8+-positive cells. (c) Immunohistochemical evaluation of CD57+-positive cells. (d) Immunohistochemical evaluation of Ki-67-positive cells. (e) Immunohistochemical evaluation of p53-positive cells.
Figure 2
Figure 2
Histomorphology and immunohistochemistry of foreskin cells from phimosis without LS. (a) Histomorphology of foreskin from phimosis without LS. (b) Immunohistochemical evaluation of CD8+-positive cells. (c) Immunohistochemical evaluation of CD57+-positive cells. (d) Immunohistochemical evaluation of Ki-67-positive cells. (e) Immunohistochemical evaluation of p53-positive cells.
Figure 3
Figure 3
Histomorphology and immunohistochemistry of foreskin cells from phimosis with LS. (a) Histomorphology of foreskin from phimosis with LS. (b) Immunohistochemical evaluation of CD8+-positive cells. (c) Immunohistochemical evaluation of CD57+-positive cells. (d) Immunohistochemical evaluation of Ki-67-positive cells. (e) Immunohistochemical evaluation of p53-positive cells.
Scheme 1
Scheme 1
Ki67: group comparison.
Scheme 2
Scheme 2
p53: group comparison.
Scheme 3
Scheme 3
CD8: group comparison.
See this image and copyright information in PMC

References

    1. Hallopeau H. Du lichen plan et particulièrement de sa forme atrophique: Lichen plan scléreux. Ann. Dermatol. Syphiligr. 1887;8:790–791.
    1. Kreuter A., Kryvosheyeva Y., Terras S., Moritz R., Möllenhoff K., Altmeyer P., Scola N., Gambichler T. Association of Autoimmune Diseases with Lichen Sclerosus in 532 Male and Female Patients. Acta Derm. -Venereol. 2013;93:238–241. doi: 10.2340/00015555-1512. - DOI - PubMed
    1. Fistarol S.K., Itin P.H. Diagnosis and Treatment of Lichen Sclerosus: An update. Am. J. Clin. Dermatol. 2013;14:27–47. doi: 10.1007/s40257-012-0006-4. - DOI - PMC - PubMed
    1. Christman M.S., Chen J.T., Holmes N.M. Obstructive complications of lichen sclerosus. J. Pediatr. Urol. 2009;5:165–169. doi: 10.1016/j.jpurol.2008.12.007. - DOI - PubMed
    1. Dinh H., Purcell S.M., Chung C., Zaenglein A.L. Pediatric Lichen Sclerosus: A Review of the Literature and Management Recommendations. J. Clin. Aesthetic Dermatol. 2016;9:49–54. - PMC - PubMed