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Penis and scrotum
Non-neoplastic lesions of scrotum
Sclerosing lipogranuloma
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D.
Revised: 23 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● See also Tancho’s nodules / paraffinomas
Epidemiology
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● Rare; most patients are young adults
Etiology
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● Usually due to injection or topical application of oil-based substances (paraffin, silicone, oil, or wax) for cosmetic or therapeutic use (Archives 1977;101:321)
● Foreign body reaction is response to degenerated or damaged fatty tissue or lipids (Med Mol Morphol 2007;40:108)
● May also be due to trauma and cold weather
● Idiopathic cases with peripheral eosinophilia
Sites
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● Usually affects penis, scrotum, spermatic cord, perineum
Clinical features
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● Localized painless or slightly tender, indurated plaque/mass
● Up to several centimeters
Clinical images
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There is marked deformity of the penis.
Gross description (Macroscopy)
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● Firm, yellow to grayish-white areas
● Solid, or solid and cystic
● Often fragmented
Gross images
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Replacement of entire scrotal wall by solid yellow-white tissue with interspersed cysts.
Micro description (Histopathology)
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● Fat necrosis, histiocytes, giant cells with extensive fibrosis and hyalinization
● Lipid vacuoles with marked variation in size
● Cysts, if present, lack epithelial lining but may contain giant cells
● Also T lymphocyte infiltrate (Pathol Int 2003;53:121)
Micro images
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Characteristic vacuoles, sclerotic stroma, Numerous, variably sized vacuolated spaces
and occasional foreign body giant cells often lined by giant cells are separated by a
fibroinflammatory stroma
Oil red O stain
Positive stains
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● Lipid stains - Oil Red O for frozen tissue
Differential Diagnosis
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● Adenomatoid tumor: epitheliod and spindle cells, cystic spaces lined by flat, cuboidal or low columnar cells, no fat necrosis, no giant cells
● Lymphangioma: no fat necrosis, no giant cells, cystic spaces lined by endothelium
● Sclerosing liposarcoma: irregular adipocytes of variable sizes, presence of lipoblasts, usually no giant cells
End of Penis and scrotum > Non-neoplastic lesions of scrotum > Sclerosing lipogranuloma
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