The microscopic appearance of a biopsy from a penile ulcer is seen in Figure below. The biopsy shows an area of ulceration in the epiderrnis and an inflammatory infiltration in the upper and mid dermis. The inflammatory cells are lymphocytes and plasma cells, and there is marked swelling of the endothelial cells of the capillaries in the dermis. This tissue response is very suggestive ofa spirochetal infection. Warthin Starry stain showed the presence of spirochetes in the thickened stratum corneum (shown in Fig. ‘A’).
A(a) and A(b) Skin biopsy shows ulceration and pseudoepitheliomatous hyperplasia of the epidermis adjacent to the ulcer.
A(c) There is swelling of the endothelial cells of the capillaries in the dermis, and there is an infiltration of lymphocytes and plasma cells in the dermis. This pattern of inflammatory infiltration is typical of a spirochetal infection.
A(d) This section shows thickened keratin anddebris in the base of the ulcer.
A(e) Spirochetes are seen in a Warthin Starry stainin the thickened keratin layer (not in the dermis).