Penile paraffinoma: a case report

Czech version

Authors: Jan Hrudka ¹; Alexandra Gregušová ²; David Čapka ²
Authors‘ workplace: Ústav patologie 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha. ¹; Urologická klinika 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha. ²
Published in: Čes.-slov. Patol., 58, 2022, No. 1, p. 52-56
Category: Original Articles

Overview

Penile paraffinoma or sclerosing lipogranuloma is a disease occurring uncommonly in Czechia; a pathologist meets this only rarely. Microscopically, we deal with chronic fibroproductive inflammation localised usually in subcutaneous tissue of the penis. It is caused by previous voluntary injection of liquid paraffin / mineral oil for the purpose of penis circumference augmentation, usually performed by a non-healthcare person or by the patient himself. Human tissues do not have enzymes that can break down synthetic lipids. The application leads, with a variable time lag, to a foreign body giant-cell reaction lasting for years, and often to annoying complications frequently associated with a genital mutilation and sexual dysfunction. The lesion often requires surgical treatment to remove the paraffin substance from the subcutaneous tissue. The surgery does not always lead to satisfying results and the paraffinoma tends to recur. In this article, we describe a case of a man with relapsing paraffinoma, which required excision of subcutis with subsequent plastic surgery with skin graft. During histological examination, lipid droplets were found in dermis and in subcutis, along with xantogranulomatous inflammation. The lipid nature of the material was proven by oil red and Sudan stain. The paper includes clinical and histopathological differential diagnostic consideration, summary of treatment options and relevant literature review.

Keywords:

Penis – penile – paraffinoma – sclerosing – lipogranuloma

Sources

1. Kodet R. Zánět. In: Zámečník J (Ed.) Patologie. Praha: LD Prager Publishing; 2019: Svazek 1, 109, 122-124.

2. Picozzi SC, Carmignani L. Paraffinoma of the penis. Int J Emerg Med. 2010; 3(4):507-8.

3. Downey AP, Osman NI, Mangera A, Inman RD, Reid SV, Chapple CR. Penile Paraffinoma. Eur Urol Focus 2019; 5(5): 894-898.

4. Cohen JL, Keoleian CM, Krull EA. Penile paraffinoma: self-injection with mineral oil. J Am Acad Dermatol 2002; 47(5 Suppl): 251-253.

5. Ahmed U, Freeman A, Kirkham A, Ralph DJ, Minhas S, Muneer A. Self injection of foreign materials into the penis. Ann R Coll Surg Engl 2017; 99(2): 78-82.

6. Akkus E, Iscimen A, Tasli L, Hattat H. Paraffinoma and ulcer of the external genitalia after self-injection of vaseline. J Sex Med 2006; 3(1): 170-172.

7. Alcalde-Alonso M, Velasco-Albendea FJ, Soto-Díaz A, Gómez-Avivar P, Torres-Gómez FJ. Paraffinoma of the penis and scrotum (sclerosing granuloma of the male genitalia). Indian J Dermatol Venereol Leprol 2017; 83(1): 75-77.

8. Al-Khalil N, Panchev P, Tsvetkov M, Simeonov P, Mladenov D. A case of penis self-injection of liquid paraffin-operative treatment and results. Khirurgiia (Sofiia) 2004; 60(3): 65-66.

9. Bachmeyer C, Moguelet P, Gombeaud T, Sbidian E, Aractingi S. Penile paraffinoma developing during treatment with pegylated interferon alfa-2a for chronic hepatitis C virus infection. Arch Dermatol 2011; 147(10): 1232- 1233.

10. Bayraktar N, Başar I. Penile paraffinoma. Case Rep Urol. 2012;2012:202840.

11. Bobik O Jr, Bobik O Sr. Penile paraffinoma and ulcers of penis. Bratisl Lek Listy 2011; 112(11): 653-654.

12. Bjurlin MA, Carlsen J, Grevious M, et al. Mineral Oil-induced Sclerosing Lipogranuloma of the Penis. J Clin Aesthet Dermatol 2010; 3(9): 41-44.

13. Chon W, Koo JY, Park MJ, Choi KU, Park HJ, Park NC. Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction. World J Mens Health 2017; 35(2): 129-132.

14. Choudhury N, Frame JD, Lewi HJ. Penile paraffinoma and a novel treatment. BJU Int 2003; 92 Suppl 3: e14.

15. Ciancio SJ, Coburn M. Penile salvage for squamous cell carcinoma associated with mineral oil injection. J Urol 2000; 164: 1650.

16. Cormio L, Di Fino G, Scavone C, et al. Magnetic resonance imaging of penile paraffinoma: case report. BMC Med Imaging 2014; 14: 39.

17. De Siati M, Selvaggio O, Di Fino G, et al. An unusual delayed complication of paraffin self-injection for penile girth augmentation. BMC Urol 2013;13: 66.

18. Dimitrowa J, Balabanowa M, Zarnuschanow P, Scharow P. Sklerosierendes Lipogranulom der männlichen Genitalien. Z Hautkr 1989; 64(3): 223-227.

19. Eandi JA, Yao AP, Javidan J. Penile paraffinoma: the delayed presentation. Int Urol Nephrol 2007; 39(2): 553-555.

20. Foxton G, Vinciullo C, Tait CP, Sinniah R. Sclerosing lipogranuloma of the penis. Australas J Dermatol 2011; 52(3): 12-14.

21. Francis J, Poh Choo Choo A, Wansaicheong Khin-Lin G. Ultrasound and MRI features of penile augmentation by „Jamaica Oil“ injection. A case series. Med Ultrason 2014; 16(4): 372-376.

22. Gfesser M, Worret WI. Paraffinome des Penis. Hautarzt 1996;47(9): 705-707.

23. Gómez-Armayones S, Penín R, Marcoval J. Parafinoma de pene. Actas Dermosifiliogr 2014; 105: 957–959.

24. Gröger A, Boliglowa D, Sippel C, Wiebols A, Menke H. Komplikation durch Selbstinjektion mit Vaseline zur Penisaugmentation. Urologe A 2015; 54(3): 397-399.

25. Hohaus K, Bley B, Köstler E, Schönlebe J, Wollina U. Mineral oil granuloma of the penis. J Eur Acad Dermatol Venereol 2003; 17(5): 585- 587.

26. Inn FX, Imran FH, Ali MF, Ih R, Z Z. Penile augmentation with resultant foreign material granuloma and sequalae. Malays J Med Sci 2012; 19(4): 81-83.

27. Jeong JH, Shin HJ, Woo SH, Seul JH. A new repair technique for penile paraffinoma: bilateral scrotal flaps. Ann Plast Surg 1996; 37(4): 386-393.

28. Jindarak S, Angspatt A, Loyvirat R, Chokrungvaranont P, Siriwan P. Bilateral scrotal flaps: a skin restoration for penile paraffinoma. J Med Assoc Thai 2005; 88 Suppl 4: 70-73.

29. Karakan T, Ersoy E, Hasçiçek M, Ozgür BC, Ozcan S, Aydın A. Injection of Vaseline under Penis Skin for the Purpose of Penis Augmentation. Case Rep Urol 2012; 2012: 510612.

30. Kalsi JS, Arya M, Peters J, Minhas S, Ralph DJ. Grease-gun injury to the penis. J R Soc Med 2002; 95(5): 254.

31. Kim SW, Yoon BI, Ha US, Kim SW, Cho YH, Sohn DW. Treatment of paraffin-induced lipogranuloma of the penis by bipedicled scrotal flap with Y-V incision. Ann Plast Surg 2014; 73(6): 692-695.

32. Kim JS, Shin YS, Park JK. Penile skin preservation technique for reconstruction surgery of penile paraffinoma. Investig Clin Urol 2019; 60(2): 133-137.

33. Lee SW, Bang CY, Kim JH. Penoscrotal reconstruction using groin and bilateral superomedial thigh flaps: a case of penile vaselinoma causing Fournier‘s gangrene. Yonsei Med J 2007;48(4): 723-726.

34. Majedah S, Hanafiah M, Awang MK. MRI findings of penile paraffinoma. BMJ Case Rep 2014; 2014: bcr2014205448.

35. Manjit S, Vikramjit S, Clarence LC. Penile Paraffinoma. Med J Malaysia 2015; 70(6): 361-362.

36. Manny T, Pettus J, Hemal A, Marks M, Mirzazadeh M. Penile sclerosing lipogranulomas and disfigurement from use of „1Super Extenze“ among Laotian immigrants. J Sex Med 2011; 8(12): 3505-3510.

37. May JA, Pickering PP. Paraffinoma of the penis. Calif Med 1956; 85(1): 42-44.

38. Morales-Raya C, Calleja-Algarra A, Tous-Romero F, Rivera-Díaz R. Penile Paraffinoma: Should We Perform Ultrasound? Actas Dermosifiliogr 2017; 108(5): 478-480.

39. Nyirády P, Kelemen Z, Kiss A, Bánfi G, Borka K, Romics I. Treatment and outcome of vaseline- induced sclerosing lipogranuloma of the penis. Urology 2008; 71(6): 1132-1137.

40. Oñate Celdrán J, Sanchez Rodríguez C, et al. Penile paraffinoma after subcutaneous injection of paraffin. Treatment with a two step cutaneous plasty of the penile shaft with scrotal skin. Arch Esp Urol 2012; 65(5): 575-578.

41. Pehlivanov G, Kavaklieva S, Kazandjieva J, Kapnilov D, Tsankov N. Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma). J Eur Acad Dermatol Venereol 200; 22(7): 845-851.

42. Pereira-Lourenço M, Vieira E Brito D, Godinho R, Rabaça C. Giant Penis paraffinoma. Rev Int Androl 2020: S1698-031X(20)30029-7.

43. Pónyai K, Marschalkó M, Hársing J, et al. Paraffinoma. J Dtsch Dermatol Ges 2010; 8(9): 686-688.

44. Rosellen J, Pflüger M, Bach A, Steffens J, Kranz J. Penile Paraffinome – therapeutische Strategien. Urologe A 2020; 59(11): 1371-1376.

45. Rosenberg E, Romanowsky I, Asali M, Kaneti J. Three cases of penile paraffinoma: a conservative approach. Urology 2007; 70(2): 372. e9-10.

46. Santos P, Chaveiro A, Nunes G, Fonseca J, Cardoso J. Penile paraffinoma. J Eur Acad Dermatol Venereol 2003; 17(5): 583-584.

47. Santucci RA, Zehring RD, McClure D. Petroleum jelly lipogranuloma of the penis treated with excision and native skin coverage. Urology 2000; 56(2): 331.

48. Sejben I, Rácz A, Svébis M, Patyi M, Cserni G. Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia. Can Urol Assoc J 2012; 6(4): E137-139.

49. Shin YS, Zhao C, Park JK. New reconstructive surgery for penile paraffinoma to prevent necrosis of ventral penile skin. Urology 2013; 81(2): 437-441.

50. Soyer HP, Petritsch P, Glavanovitz P, Kerl H. Sklerosierendes Lipogranulom (Paraffingranulom) des Penis unter dem klinischen Bild eines Karzinoms. Hautarzt 1988; 39(3): 174-176.

51. Salauddin SA, Ghazali H. Surgical Techniques for Correction of Penile Paraffinoma. Malays J Med Sci 2019; 26(6): 137-142.

52. Terada T, Minami S, Onda H, et al. Primary sclerosing lipogranuloma with broad necrosis of the scrotum. Pathol Int 2003; 53(2): 121-125.

53. Tsili AC, Xiropotamou ON, Nomikos M, Argyropoulou MI. Silicone-induced Penile Sclerosing Lipogranuloma: Magnetic Resonance Imaging Findings. J Clin Imaging Sci 2016; 6: 3.

54. Moon DG, Yoo JW, Bae JH, Han CS, Kim YK, Kim JJ. Sexual function and psychological characteristics of penile paraffinoma. Asian J Androl 2003; 5(3): 191-194.

55. Bednář B, et al. Patologie. Avicenum, Zdravotnické nakladatelství, Praha, 1986. Svazek 1, 276-280.

56. Ro JY, Divatia MK, Kim KR, Amin MB, Ayala AG. Penis and Scrotum, in: Cheng L, MacLennan GT, Bostwick DG (Eds.), Urologic Surgical Pathology, fourth edition, Elsevier, Philadelphia, 2020: 867-868.

57. Hes O. Urologická patologie. In: Zámečník J (Ed.) Patologie. Praha: LD Prager Publishing; 2019: Svazek 2, 599.