title: Review of 120 biopsies performed on the balanopreputial sac. from zoon's balanitis to the concept of a wider spectrum of inflammatory non-cicatricial balanoposthitis.
abstract: BACKGROUND
  Long-lasting erythematous lesions involving the balanopreputial sac may be clinically difficult to classify, and biopsies may be performed in order to clarify the nature of the disease. However, our previous experience led us to consider several cases as histopathologically unclassifiable.
  
  
  OBJECTIVE
  To establish the causes of such unsatisfactory findings.
  
  
  METHODS
  We reviewed 120 balanopreputial sac biopsies performed at the surgical unit of our institute from January 1999 to December 2002 examining also the patients' clinical records.
  
  
  RESULTS
  We found that a small group of previously unclassified cases showed common clinical and histopathological features. Clinically, all patients were uncircumcised and had long-lasting asymptomatic erythematous plaques on the balanopreputial sac with no erythroplastic or lichenoid features and no correlation with sexual intercourse. Histologically, all specimens showed a thinned and spongiotic epithelium, a band-like infiltrate of lymphocytes and histiocytes with a variable number of plasma cells in the upper part of the chorion and further signs of acute, subacute or chronic inflammation.
  
  
  CONCLUSIONS
  In our view, these cases fall within a spectrum of inflammatory non-cicatricial disorders, ranging from almost pure lymphohistiocytic forms to forms which fulfil all criteria to be classified as balanitis circumscripta plasmacellularis of Zoon. We propose to classify these cases histologically as inflammatory non-cicatricial balanoposthitis and clinically as idiopathic inflammatory non-cicatricial balanoposthitis.
authors.affiliation: Institute of Dermatological Sciences of the University of Milan, IRCCS Ospedale Maggiore, Milan, Italy. elvio.alessi@unimi.it
authors.forename: Elvio
authors.initials: E
authors.lastname: Alessi
authors.forename: Antonella
authors.initials: A
authors.lastname: Coggi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Gianotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001446:Balanitis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D001707:Biopsy, Needle; D015331:Cohort Studies; D046508:Culture Techniques; D006801:Humans; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index