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Case of the Week #228

11 January 2012 - Case of the Week #228

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Thanks to Dr. Sushama Desai, Krishna Institute of Medical Sciences University (India), for contributing this case and the discussion. We have increased our Case of the Week payment for contributors to $50. Just send us diagnostic images, the diagnosis and a brief clinical history. We will write up the discussion (unless you want to). Right now, our queue is short, so cases submitted will be posted soon. Other guidelines are posted on the Case of the Week page.

Web Focus: Laboratory Investigation on renal pathology

Kidney disease affects over 26 million Americans, resulting in a high demand for elucidating the pathways that lead to renal pathologies and identifying potential therapeutic targets. In this Web Focus presented by Laboratory Investigation, recent research in the field of renal pathology is highlighted.

Click here for the articles.


Website news:

(1) To make them easier to use, we now have only one Stains chapter and one CD Markers chapter. We are also adding and updating topics more frequently in these chapters. Recent updates include 15-PGDH, CAM5.2, CD24, CK7, deltaNp63 (p40), Reg IV.

(2) We have added a CME / Apps / Board review page on the Home Page, left side, or click here. It lists CME, apps for smart phones / tablets and Board review questions and books. Contact us with any additions at NatPernick@hotmail.com.

(3) Our Feature Page for the month highlights Billing / consulting / management, and includes AdvantEDGE Healthcare Solutions (AHS), Pathology Service Associates, LLC and Vachette Pathology. Also check out our new monthly Mystery Image, on the right side of the Home Page.

Case of the Week #228

Clinical History:

A healthy 14 year old boy presented with chronic, asymptomatic, recurrent scrotal and penile swelling of 2.5 years duration. He had no other signs or symptoms. All laboratory and radiological investigations were normal. A scrotal biopsy was obtained.

Clinical images:



Micro images:


What is your diagnosis?


Granulomatous lymphangitis of the scrotum and penis


Granulomatous lymphangitis should be considered in the differential diagnosis of chronic idiopathic swelling of the genitalia, particularly in younger individuals. Most cases of granulomatous lymphangitis occur subsequent or concomitant with Crohn’s disease of the bowel, which some consider to be fundamentally a lymphocytic and granulomatous lymphangitis (Gut 2008;57:1). Granulomatous lymphangitis is also associated with orofacial granulomatosis (granulomatous cheilitis and Melkersson-Rosenthal syndrome) (J Cutan Pathol 2001;28:419).

Only a few cases of granulomatous lymphangitis are documented in children who never developed Crohn’s disease with bowel involvement. Pathogenesis of this isolated form is not clear. It could be a “form fruste” of Crohn’s disease, a bacterial / viral disorder or a distinct entity. Long term follow up is recommended to look for any evidence of Crohn's disease.

Treatment with topical and systemic steroids, metronidazole, sulfasalazine or immunosuppressive therapy is usually effective.

Nat Pernick, M.D., President
and Liz Parker, B.A., Associated Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com