Castleman’s disease presenting as a penile cutaneous horn

Abstract

A 70-year-old heterosexual man attended the urology outpatient department complaining of penile discomfort for several months. On examination a 2 cm conical lesion projecting from the left side of his penile glans, consistent with a clinical diagnosis of a cutaneous horn of the penis, was noted (Figure 1). A wide local excision of the lesion was performed and pathological examination demonstrated hyperkeratosis of the stem consistent with a cutaneous horn. Further analysis of the base of the horn revealed a highly vascular tumour characterised by cells with an abnormal elongated shape, called spindle cells, in keeping with a rare case of Kaposi sarcoma (KS). A staging CT scan showed widespread inguinal, para-aortic, axillary and mediastinal lymphadenopathy (Figure 2). The most accessible node in the axilla was excised with histology demonstrating the so-called “onion skinning” of the mantle zone lymphocytes and hyalinisation of small vessels within the germinal centre with a lollipop sign pathognomonic of CD (Figure 3). Immunofluorescence was positive for Human Herpes Virus 8 (HHV-8). Hepatitis, Human Immunodeficiency Virus (HIV) and Tuberculosis serology were negative. Ganciclovir was commenced, but unfortunately further cutaneous lesions appeared on his limbs and trunk and he passed away from his disease 3 months later.