Granulomatous lymphangitis of the scrotum and penis
Report of a case and review of the literature of genital swelling with sarcoidal granulomatous inflammation
Article first published online: 20 DEC 2001
Journal of Cutaneous Pathology
Volume 28, Issue 8, pages 419–424, September 2001
How to Cite
Murphy, M. J., Kogan, B. and Carlson, J. A. (2001), Granulomatous lymphangitis of the scrotum and penis. Journal of Cutaneous Pathology, 28: 419–424. doi: 10.1034/j.1600-0560.2001.028008419.x
- Issue published online: 20 DEC 2001
- Article first published online: 20 DEC 2001
- Accepted February 12, 2001
Background: Acquired lymphedema of the genitalia is a rare childhood presentation and is more common in elderly individuals secondary to pelvic/abdomenal malignancy or its therapy or worldwide due to filariasis.
Objective: Herein, we report a case of a healthy 11-year-old boy who presented with a 1-year history of chronic, asymptomatic scrotal and penile swelling. Biopsy revealed edema, lymphangiectases and peri- and intralymphatic sarcoidal type granulomas. This histologic pattern of granulomatous lymphangitis is most commonly associated with orofacial granulomatosis (granulomatous cheilitis and Melkersson-Rosenthal syndrome) and Crohn’s disease. Treatment with topical steroids and physical support has resulted in marked improvement. No systemic disease (Crohn’s disease) is evident 1 year later. Literature review revealed 44 cases of genital lymphedema with non-infectious granulomas. The majority of these young patients had Crohn’s disease, frequently with anal involvement and a minority, both with and without Crohn’s disease, had orofacial granulomatosis.
Conclusions: Granulomatous lymphangitis should be considered in the differential diagnosis of chronic idiopathic swelling of the genitalia, particularly in younger individuals. Further clinical examination, additional laboratory studies and close follow-up for co-existing or subsequent development of Crohn’s disease should be performed. The overlap between granulomatous lymphangitis of the genitalia, Crohn’s disease and orofacial granulomatosis suggest that granulomatous lymphangitis of the genitalia may represent a forme fruste of Crohn’s disease.