COMPOSITION OF THE INFLAMMATORY INFILTRATE IN PEDIATRIC PENILE LICHEN-SCLEROSUS-ET-ATROPHICUS (BLANITIS-XEROTICA-OBLITERANS) - A PROSPECTIVE, COMPARATIVE IMMUNOPHENOTYPING STUDY

Dermatopathological evaluation of pediatric preputial inflammatory dis ease rarely allows for specific diagnosis other than pediatric penile lichen sclerosus et atrophicus (balanitis xerotica obliterans, LSA/BXO ). A prospective immunopathological study was performed on 20 consecut ive, unselected, clinically and histopathologically confirmed LSA/BXO cases to determine the relative presence of T and B lymphocytes. There were seven cases with early stages of disease, eight with florid dise ase, and five with later stages of disease. Two ritual circumcision sp ecimens and 12 specimens with non-LSA/BXO balanitis, collected during the same period, were used as controls. The infiltrate in LSA/BXO pati ents was wholly composed of T cells (positive with UCLH-1 antibody) in all cases. B cells (positive with L-26 antibody) were found only foca lly in small, discreet, easily recognizable (follicular or early folli cle-like) aggregates, positioned slightly deeper than the band-like in filtrate of T cells. T cells were inconspicuous in 9 of the 12 control specimens. In the three other controls, T cells were much more obviou s and these patients showed clinical features possibly suggestive of L SA/BXO in early, prediagnosable phases of development. We conclude tha t limited immunophenotyping may be a useful adjunct to diagnosis in pe diatric cases in which only limited tissue is available or the disease may be more difficult to classify with confidence.