Lichen sclerosus on the penis associated with striking elastic fibers accumulation (nevus elasticus) and differentiated penile intraepithelial neoplasia progressing to invasive squamous cell carcinoma

LS: lichen sclerosus PeIN: penile intraepithelial neoplasia L ichen sclerosus (LS) is a chronic disorder with a predilection for the anogenital area. In this anatomic area, a subset of human papillomavirusenegative neoplasms arise on the background of chronic inflammation, of which LS is the most common condition. Of these neoplastic associations, squamous intraepithelial neoplasias, including the differentiated (simplex) type of vulvar intraepithelial neoplasia and penile intraepithelial neoplasia (PeIN), are salient lesions. A rare and unusual feature in LS is a conspicuous accumulation of elastic fibers in the level of the mid to lower part of the reticular dermis, sometimes strikingly apparent on hematoxylin-eosinestained slides. This condition was originally termednevus elasticus, but in a recent study the authors considered the process as hyperplastic. To our knowledge, there are only 3 published clinicopathologic reports describing this phenomenon.With respect to the anatomic site, all previously published examples occurred on the vulva (with exception of 5 extragenital cases). We report, a case of penile LS accompanied with conspicuous elastic fibers. Additionally, there were areas of differentiated PeIN progressing into invasive squamous cell carcinoma.