Abstract:

Primary cutaneous amyloidosis of the glans penis is a rare condition with 14 reported cases in literature to date. These patients typically present with an asymptomatic, single, tan/yellow, waxy nodule or plaque on the glans penis. Given the rarity and subtle findings of this condition, the diagnosis can be challenging both clinically and histologically. Here we present a case arising in a 66-year-old male with a history of epilepsy, static encephalopathy, and cerebral palsy who developed a macerated pink cauliflower-like papule on the glans penis with ulceration. Clinically, the lesion resembled a condyloma with the differential diagnosis of squamous cell carcinoma and penile intraepithelial neoplasia. A biopsy was performed and showed unremarkable epidermis with no keratinocyte atypia or viral cytopathic changes. Close dermal inspection showed amorphous eosinophilic infiltrates raising the suspicious for amyloid depositions. Congo red was positive and mass spectrometry amyloid typing showed AL lambda. Systemic amyloidosis screening was negative. He was treated with tacrolimus ointment and at 14-month follow-up, the lesion had grown in size with progressive induration. Evaluation for surgical removal was considered and an annual monitoring plan for systemic amyloidosis was put in place. Despite the rarity, this case highlights the importance of keeping amyloidosis as part of the differential for asymptomatic solitary nodule or plaque on the glans penis as it will affect the treatment option and monitoring plan for these patients.

Financial Disclosure:
No current or relevant financial relationships exist.

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Kelly Smith