Sclerosing lipogranuloma L92.8

Clinical and histological entity characterized by the formation of solid, usually flat nodules, nodules or plaque of indurated adipose tissue, which histologically turn out to be a lipophilic granuloma with oily cysts. An increase in symptoms may occur over the course of months.

Since there are always cases of illness without any recognisable external cause, between:

• Primary (idiopathic) sclerosing lipoganulomas
• Secondary (exogenous) sclerosing lipoganulomas

differentiated.

The primary (idiopathic) sclerosing lipoganulomas are to be addressed as idiopathic panniculitides. Infestation of the scrotum.

Exogenous sclerosing lipogranulomas (involvement of the penile shaft) are caused by the injection of foreign materials such as oils, silicones, kerosenes which are mostly used for body modeling (Sarica Ö et al. 2016; Tsili AC et al. 2016). Furthermore, sclerosing lipogranulomas can develop after injection of drugs (Li Z et al. (2018). In isolated cases, relevant histoeosinophilia may occur (Shan SJ et al. 2014; Eosinophilic sclerosing lipogranuloma). Less common is hematoeosinophilia.

Recently, in the bodybuilder scene, so-called "site enhancing oils (SEO)" are injected into backwardly developed muscle groups to achieve a desired size and symmetry. The SEO `s usually consist of a combination of lidocaine, alcohol and various oils (Petersen E et al. 2018).

Body trunk, face, scrotum, penis shaft (sclerosing lipogranuloma of the penis)

Subcutaneously located, nodular or plate-like, solid, painless, whitish or yellowish skin-coloured infiltrates. The overlying skin is included. The areas can slowly enlarge over years due to a smouldering reaction of the free body.

Before a surgical intervention, a sonographic or MRI display of the cutaneous/subcutaneous or intramuscular nodes is recommended (Tsili AC et al.2016).

Panniculitis with oil cysts, multinuclear giant cells and, in the case of prolonged persistence, with a prominent fibrosis.

In case of cosmetic or mechanical disorder excision.

Due to the tabooing of SEOs, most patients are reluctant to disclose this important anamnestic information (Foxton G et al. 2011). Watanabe D et al. (2014) reported 224 cases of primary sclerosing (idiopathic) lipogranulomas of the penis where the cause could not be determined.

A 41-year-old former competitive bodybuilder was admitted for the excision of a subcutaneous knot on the shaft of his penis due to suspected lymphoma.

Histologically a sclerosing lipogranuloma with oil cysts was detectable. Focally clear histoeosinophilia.

Subsequently, after insitating questioning, the injection of SEO 's was confirmed. The composition of the filler material could no longer be determined.

1. Foxton G et al (2011) Sclerosing lipogranuloma of the penis. Australas J Dermatol 52:e12-4.
2. Li Z et al (2018) Sclerosing lipogranuloma presenting as movable masses induced by large doses of progesterone injection. J Dermatol 45:e114-e115.
3. Mungan S et al. (2014) A giant primary sclerosing lipogranuloma of the scrotum. Turk Patoloji Derg 30:78-80.
4. Petersen E et al (2018) No pain no gain: tender nodules in a competitive bodybuilder. Dermatol Online J 24 pii:13030/qt5w91h58x.
5. Sarıca Ö et al.(2016) Subcutaneous Oleomas Following Sunflower Oil Injection: A Novel Case and Review of Literature. J Breast Health. 12:141-144.
6. Shan SJ et al (2014) Exenatide-induced eosinophilic sclerosing lipogranuloma at the injection site.Am J Dermatopathol 36:510-512.
7. Tsili AC et al (2016) Silicone-induced Penile Sclerosing Lipogranuloma: Magnetic Resonance Imaging Findings. J Clin Imaging Sci 6:3.
8. Watanabe D et al (2014) Case of primary scrotal sclerosing lipogranuloma: review of 227 cases reported in Japan. Hinyokika Kiyo 60:587-591.