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Összefoglaló. Bevezetés: A hímtag körméretének növelése érdekében, az annak bőre alá bejuttatott zsírnemű anyag szklerotizáló lipogranulomát okoz. Hazánkban a szklerotizáló lipogranuloma okozta hímvessző-deformitások kezelésének legelterjedtebb módszere a két ülésben végzett bőrpótlás. Ennek ellenére a magyar nyelvű szakirodalomban kevés adat áll rendelkezésre a kétüléses műtét eredményességéről és várható szövődményeiről. Célkitűzés: Tanulmányunkban a szklerotizáló lipogranuloma okozta deformitások miatti – két ülésben végzett – hímvesszőbőr-helyreállítással szerzett tapasztalatainkról, a műtét után kialakuló szövődményekről számolunk be retrospektív adatgyűjtés alapján. Módszer: 2008. március 1. és 2020. március 1. között a Debreceni Egyetem Urológiai Klinikáján 17 betegen végeztünk kétüléses hímvesszőbőr-helyreállító műtétet. A szklerotizáló lipogranuloma által érintett bőrt teljes mértékben eltávolítottuk, majd a lecsupaszított hímtagot a herezacskó elülső felszínén kialakított subcutan csatornába helyeztük. A második ülés során a herezacskó bőre alá ültetett hímvesszőt felszabadítottuk. Eredmények: A Clavien–Dindo-beosztás szerint az első ülés után három, a második ülés után egy I. gradusú szövődmény alakult ki; II–V. gradusú szövődményt nem figyeltünk meg. Azon 9 beteg közül, akik mindkét ülésen átestek, 7 beteg elégedett volt a beavatkozás eredményével, 2 beteg korrekciós műtéten esett át fél és 9 évvel a második ülés után. A 8 beteg közül, akik csak ez első ülést vállalták, egy korrekciós műtét történt 4 hónappal a műtét után. Következtetés: A hímvessző szklerotizáló lipogranulomája esetén az érintett bőrterület kimetszése után hímvesszőbőr-helyreállítás szükséges. A herezacskó-bőrlebeny alkalmazásának előnye, hogy a herezacskó színe és elaszticitása a hímvesszőbőréhez hasonló, a tapintás- és erogén érzet megmarad. A kétüléses hímvesszőbőr-helyreállítás kevés szövődménnyel, plasztikai sebészeti jártasság nélkül elvégezhető. Orv Hetil. 2021; 162(35): 1413–1417. Summary. Introduction: Subcutaneous injection of liquid fatty materials to enhance penile girth induce sclerosing lipogranuloma of the penis. In spite of its well known severe consequences there has been a persistent use of this practice in non-medical circumstances. Objective: The aim of this paper is to present our observations with staged penile skin reconstruction for sclerosing lipogranuloma and to evaluate postoperative complications in a retrospective manner. Method: Between 2008 and 2020, 17 patients underwent surgery to treat sclerosing lipogranuloma of the penis by staged penile skin reconstruction at our department. Complete exscision of the involved tissue was performed, then the denuded penile shaft was inserted into a subcutaneous channel on the anterior side of the scrotum during the first stage. The second stage of reconstruction consisted of releasing the penile shaft from the scrotum. The second stage was performed merely on 9 in 17 patients. Results: According to the Clavien–Dindo classification system, 3 grade I and 1 grade I complications occurred in the postoperative period after the first and second stage, respectively. Grade II–V complications were not observed. 7 of 9 patients who underwent both stages were satisfied with the final result, 2 patients had minor correction surgery 6 months and 9 years following the second stage. 1 of 8 patients who underwent only the first stage had minor correction surgery 4 months following the operation. Conclusion: In case of sclerosing lipogranuloma of the penis, excision of the affected tissue and reconstruction of the penile skin are indicated. Advantages of using scrotal skin flaps are that colour and elasticity of the scrotal skin are similar to penile skin, erogenous sensation of the scrotal flap remains intact. Applying staged penile skin reconstruction with scrotal skin flap has the advantage of few postoperative complications and it is easy to perform. Orv Hetil. 2021; 162(35): 1413–1417.

Objective Sclerosing lipogranuloma of the penis is a relatively rare disorder associated with injection of illicit foreign materials for penile augmentation. We aim to report the clinical presentation, diagnosis, treatment, and outcomes of patients with this condition, and to review the most relevant literature currently available. Background Injection of mineral oil into the subcutaneous tissues of the penis for augmentation has been practiced since ancient times. The potential for complications has long been known, and most doctors have abandoned the procedure. However, it is still practiced in some parts of the world. The complications may be devastating including death from embolism or sepsis. The affected area may not be restricted to the injection site, potentially involving the scrotal and suprapubic areas. Surgery with complete removal of the involved tissue followed by covering the denuded area with a graft or skin flap is the best therapeutic option. Methods The literature search involved keywords such as penis, augmentation, enlargement, sclerosing, lipogranuloma, penile injection, paraffinoma, and was obtained from computerized search of databases such as PubMed, Google Search and Scopus. Personal experience of the lead author (BS) is also described. We tried arbitrarily to limit our search to articles including ≥5 patients pertaining to the subject of our review and, therefore, excluded single case reports. However, a single systematic search of PubMed and Scopus was also found and included. Conclusions The treatment of choice is radical excision of all the lesions followed by skin grafting. Bearing in mind that prospective, randomized, controlled studies are considered difficult to carry out, further work will continue apparently to be based on case series by individual surgeons. It is critical to advise patients to separate the myths from the facts and use preventive measures through awareness and education to best minimize the downsides of this problem.

The authors present a clinical observation of oleogranuloma of the penis in an adolescent. The analysis of domestic and foreign literature demonstrates the absence of this nosology in adolescence. The relevance of oleogranuloma of the penis and modern tactics of surgical treatment are highlighted.

A lipogranuloma is a complication of injecting exogenous oily composites, forming a nodule composed of foreign body histiocytes. These may be seen in the setting of use of anabolic steroids. We present a case of a 52-year-old male with rapidly growing intramuscular masses with accompanying lymphadenopathy and constitutional symptoms. A diagnosis of lymphoma was initially made in view of the multifocal nature of his disease. CT and PET/CT scans were used to profile the extent of disease. However, US-guided biopsy samples demonstrated acute-on-chronic fibro-inflammatory connective tissue, but no evidence of malignancy. A follow-up CT scan showed resolution of most of these masses. Subsequently, a history of self-injected anabolic steroids was obtained. Familiarity of imaging characteristics of lipogranuloma may be helpful in avoiding the pitfall of misdiagnosis in this clinical setting.

Aging is a physiological process that progresses both physically and mentally. In today's conditions, there are medical devices and cosmetic procedures that support the external appearance and make the person feel good socially in order to age well. Over the years, thanks to the advancing technology, different solutions have been developed to compensate the loss of facial volume due to aging. Although the use of dermal fillers increases with each passing year, their excessive costs, and the need for periodic repetition force people to seek different and unhealthy solutions. In this study, we present a 32-year-old female patient who was injected with egg white in both nasolabial folds and presented with widespread redness and tenderness on the face. Surgical excision was performed after systemic corticosteroid therapy. The patient's granulomas excised from the mouth were reported as lipogranuloma by the pathology department. The frequency of foreign substance injections for cosmetic purposes has increased in recent years. Early diagnosis and follow-up is critical in the treatment of these cases., Yaşlanma hem fiziksel hem de ruhsal olarak ilerleyen, fizyolojik bir süreçtir. Günümüz şartlarında güzel bir şekilde yaşlanmak için, dış görünümü destekleyen ve kişinin kendini sosyal olarak iyi hissetmesini sağlayan medikal cihazlar ve kozmetik prosedürler mevcuttur. Gelişen teknoloji sayesinde yıllar içinde, yaşlanma nedeni ile olan yüzdeki volüm kaybını kompanse etmek için farklı çözümler türemiştir. Dermal dolguların kullanım sıklığı her geçen yıl artsa da, yüksek maliyetleri ve belli aralıklarla tekrarlanma gereksinimleri insanları farklı ve sağlıksız çözümler aramaya itmektedir. Bu çalışmada her iki nazolabial katlantıya yumurta akı enjekte edilen, yüzde yaygın kızarıklık ve hassasiyet ile başvuran, 32 yaşında bir kadın hastayı sunduk. Hastaya sistemik kortikosteroid tedavisinin ardından cerrahi eksizyon yapıldı. Hastanın ağız içinden eksize edilen granülomları patoloji sonucuna göre lipogranülom olarak belirlendi. Yüze kozmetik amaçlı yapılan yabancı madde enjeksiyonların sıklığı son yıllarda artış göstermektedir. Bu olguların tedavisinde erken tanı ve takip kritik önem taşımaktadır.

La silicona líquida se ha usado desde hace varias décadas como material médico. En urología, se ha utilizado para el engrosamiento peneano, inyectándose en el tejido celular subcutáneo, lo que puede producir una reacción inflamatoria granulomatosa con deformidad local, dando lugar a una reacción a cuerpo extraño denominada “siliconoma”. Presentamos el caso de un paciente con lipogranuloma peneano secundario a inyección de sustancia extraña que precisó de tratamiento quirúrgico para exéresis del tejido afectado y cobertura del defecto con injertos cutáneos. Concluimos que este tipo de prácticas no están justificadas ya que pueden tener consecuencias catastróficas

Lipogranulomas of the mammary glands: diagnosis and treatment. Steatonecrosis of the mammary gland is necrosis of its adipose tissue, followed by replacement with scar tissue. Lipogranuloma is known as a benign inflammatory process, necrosis of breast fat occurs due to iatrogenic breast trauma. Most often, fatty necrosis is seen in women with large breasts – in women with small breasts, it develops much less often. It is important to diagnose lipogranulomas because it can often mimic breast cancer. Fat necrosis of the breast is a common pathological condition, with a wide variety of presentations on mammography, ultrasound and MRI. The incidence of fatty necrosis of the breast is estimated at 0.6%, representing 2.75% of all breast lesions

Penile paraffinoma is a rare condition after penile injection of liquid paraffin or other mineral oils, with well-documented debilitating complications. Nevertheless, such injections are still performed by people of Eastern European and Asian descent for cosmetic penile augmentation. We report a case of penile paraffinoma in an otherwise healthy, 30-year-old male, with obstructive lower urinary tract symptoms (LUTS) as the sole complaint at presentation in the emergency department and a conservative approach. This case report describes an unusual presentation of penile paraffinoma in a young man and aims to raise public and physician awareness regarding disease manifestation to prevent high morbidity from delayed diagnosis and treatment.

Objective: To investigate the clinical features of patients who develop periorbital lipogranuloma after injection of autologous fat. Methods: This retrospective case series included 18 patients who developed a periorbital mass or swelling after undergoing injection of autologous fat for facial augmentation. The patients’ medical records were reviewed for clinical history, radiologic findings, and treatment outcomes. Results: All patients were women aged 24 to 50 years (mean, 31.6 years). Five patients (27.8%) involved both orbits. Presenting eye symptoms were a palpable mass (61.1%), eyelid swelling (44.4%), and ptosis (16.7%). The interval between the final injection and onset of eye symptoms ranged from 1 to 36 months (mean, 11.5 months). Thirteen patients underwent radiologic imaging. Fifteen patients received only one injection of autologous fat and three received two injections with the cryopreserved fat used in the second injection. Surgical excision was performed in 12 patients to remove the mass and identify the pathologic abnormalities. No recurrence was found during 1 year of follow-up. Two of the six patients who had refused treatment showed spontaneous resolution at the 6-month visit. Conclusion: Periorbital lipogranuloma after facial injection of autologous fat should be considered as a specific orbital disease entity for which MRI is an effective examination method. Surgery is warranted for this condition when conservative treatment is ineffective.

Autologous fat transfer is an increasingly popular surgical procedure with many applications in the cosmetic realm and beyond. It is found to be an efficacious procedure, but there is growing concern over adverse effects.1, 2 Potential risks include common complications such as fat necrosis, seroma formation, and cellulitis.1 More serious complications have also been reported, including life-threatening infections and potentially fatal fat emboli, especially in gluteal fat transfer.1, 3 The American Society of Plastic Surgeons recently issued a warning identifying gluteal fat grafting as the aesthetic procedure with the highest mortality rate (1 in 3000 procedures).4 Historically, use of silicone for gluteal enhancement has resulted in numerous cases of granulomatous foreign body–like reactions.5, 6 Theoretically, the use of autologous tissue would decrease the incidence of these reactions. Here we report the first case, to our knowledge, of a granulomatous reaction to autologous fat transfer in the gluteal region.

Nowadays lip augmentation with FDA-approved fillers is becoming popular. However, because of financial concerns many patients seek for unregistered materials. Here, we report two cases who use vitamin E for lip augmentation. They experience severe infiltration and discharge less than one month after injection. Biopsy revealed lipogranuloma formation. They were treated with incision and drainage, antibiotic, and corticosteroids. Although these complications are usually difficult to treat, the patients had good clinical response and no recurrence in 5-month follow-up.

OBJECTIVE: Penile implants and injection of foreign materials have been described in texts like Kama Sutra for more than 1500 years, and are still being practiced around the world. The extent of this practice is unknown, and the documentation available today only scratches the surface. This study investigates and documents the complications after penile self-injections at the Mae Tao Clinic. To our knowledge, this study represents the largest series of patients representing complications to penile self-injections.STUDY DESIGN: Retrospective study.METHODS: We investigated data on 680 patients admitted with penile self-injections during a 5-year period. Data were studied for general patient data, symptoms, time of injection, and treatment.RESULTS: Age at admittance ranged from 17 to 68 with a mean age of 32 years. Time between injection and presentation was registered with a mean of 36.7 months, over half presented with complications within 1 year. Most frequent complications were penile pain (84%), swelling (82.5%), induration (42.9%), purulent secretion (21.8%), and ulceration (12.8%). Of the 680 patients, 507 (74.6%) underwent surgical treatment (503 excision and 4 circumcision), while 173 (25.4%) were treated conservatively.CONCLUSION: Our data suggest that penile self-injections with mineral oil are more prevalent in certain areas than previously acknowledged. In 5 years, more than 680 patients presented with complications to penile self-injections, of which 75% needed surgical intervention, mainly in the form of radical excision of the lesions followed by skin grafting. Preventive measures to this physically and psychologically devastating problem are highly warranted.

Objective Lipogranuloma is a rare inflammatory reactive process in the dermis and subcutis. We present a summary of the 6 cases of lipogranuloma after facial cosmetic procedures. Study Design We performed a retrospective review including patient demographic data, clinical symptoms, appearance on computed tomography, treatment, pathology results, and history of facial cosmetic procedures. Results In most cases, the nodules were painless and showed no significant growth. Computed tomography revealed ill-defined swellings in the buccal fat pad with heterogeneous density. Histopathological examinations revealed numerous variable-sized empty microcysts surrounded by abundant lymphocytes and foamy macrophages, the characteristic features of lipogranuloma. On further questioning, all of the patients revealed that they had undergone some form of facial cosmetic procedure in the preceding months to years. Among the 6 cases, facial autologous fat injection may have been the main cause of lipogranuloma. Conclusion Lipogranulomas can develop months to years after facial cosmetic procedures distant from the injection sites. A thorough understanding of the patient's medical history and the clinical and histopathologic characteristics of lipogranuloma are necessary to make a definite diagnosis and allow appropriate treatment.

Ten years ago, a 57-year-old man fell into a full oilcan, penetrating the straight spout suborbital into the right frontal lobe (figure, A). Two years later, he developed symptomatic epilepsy. A cranial MRI showed extensive edema formation (figure, B) and pathologic contrast enhancement (figure, C). In a neurosurgical biopsy, multiple granulomas around small oil droplets appeared. Histopathologic analysis revealed a chronic meningoencephalitis with granulomas and giant cells congruent with a foreign body reaction (figure, D–F).

Lipogranuloma is a rare inflammatory reactive process often reported to occur in the dermis and subcutis in the cosmetic surgery field.1 It very rarely occurs in the retroperitoneum. We present a case of retroperitoneal lipogranuloma mimicking metastases of renal cell carcinoma (RCC) after laparoscopic partial nephrectomy. A 63-year-old man who underwent laparoscopic left partial nephrectomy for RCC one year earlier had developed a left retroperitoneal tumor during postoperative surveillance. The tumor looked identical to an implant or recurrence of RCC on contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT. We resected the tumor, and pathology showed a lipogranuloma. Keywords: Lipogranuloma, Mimicking recurrence, Renal cell carcinoma

Lipogranulomas represent foreign body reactions to exogenous lipid or oil-like substances introduced into the skin. These lesions characteristically have round-to-ovoid, vacuole-like cavities of varying sizes in the dermis, which results in a Swiss cheese-like appearance. We present the case of a 51-year-old Hispanic woman with an onset of painful, swollen, subcutaneous nodules on the face, most prominently on the right lower lip and both cheeks, after multiple self-injections of vitamin A oil. Histopathology test results of the lower lip showed a superficial-to-deep, nodular and interstitial, polymorphous inflammatory infiltrate of predominantly histiocytes with necrobiotic-type granulomatous changes, lymphocytes, and plasma cells. The cheek revealed deep dermal and subcutaneous small collections of foamy/vacuolated histiocytes, without significant numbers of other inflammatory cells. Given the patient’s history of injecting oil extracted from vitamin A capsules into her skin, the light microscopic features are consistent with lipogranulomatous changes that are secondary to a local injection of foreign material. Clinicians and pathologists should be aware of the granulomatous immune reaction generated by the injection of unregulated products into the face and other areas of the body. Keywords: Vitamin A, lipogranuloma, self-injection

The strive for proficient cosmetic facial appearance is growing in the past decades. Fillers for tissue augmentation are gaining wide popularity. Uncertified products based on oleic solutions are applied by untrained staff, thus growing the risk for certain complications such as infections, allergic and irritant contact dermatitis, and lipogranuloma formation. We present a series of three cases lipogranuloma after liquid vitamin E injection for lip augmentation. In all cases, painful edema at the injected area followed the procedure. The patients were presented with erythema, firm indurations of the lips and the perioral skin, and tenderness. Histological examination of skin biopsies showed round-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with a lipogranuloma. In this paper, we propose a protocol for treatment of this specific complication with systemic corticosteroids and a broad spectrum antibiotics.

©2014 Turkish League Against Rheumatism. All rights reserved. Lipogranuloma or sclerosing lipogranuloma is an unusual benign granulomatous reaction to exogenous or endogenous lipids.1,2 Although this benign process may involve various organs, there has only been one report of axillary localization in the literature in English, which was secondary to silicone implant rupture and did not include underlying systemic disease.2

SUMMARY: Periorbital lipogranuloma is a rare complication after ESS and presently lacks specific imaging reports. The purpose of this study was to describe the CT and MR imaging features of periorbital lipogranuloma. We retrospectively reviewed 9 patients with histology-confirmed periorbital lipogranuloma. All 9 patients underwent CT and MR imaging. Five lipogranulomas were located in the right eyelid and 4 in the left eyelid, which extended into the extraconal space to some degree. The lesions displayed an irregular shape and had an ill-defined margin. Multiple, specked, or nodular foci containing fat were scattered within these lesions. The lesions demonstrated moderate heterogeneous contrast enhancement on contrast-enhanced MR imaging. The TICs showed a persistent pattern (type I) in 6 patients undergoing DCE MR imaging. Thus, an ill-defined, irregular-shaped periorbital mass with multiple foci containing fat, combined with an ESS history, can help to accurately diagnose this entity.

Objective : To report a rare case of lipogranuloma of the head & neck. Case Report : We present a 33-year old female patient with a 2-month history of left neck mass refractory to antibiotic therapy. Laboratory workup and fine needle aspiration biopsy was nondiagnostic. Excisional biopsy revealed histologic evidence of a granulomatous soft tissue reaction consistent with lipogranuloma. Lipogranuloma is a very rare finding in the head and neck which typically manifests clinically with painless palpable lymphadenopathy. Two mechanisms have been described for the etiology of lipogranulomas: (1) an exogenous foreign body reaction to either a lipid or oil-like substance, and the more rare (2) endogenous degeneration secondary to an allergic/inflammatory mechanism as a result of severe heat/cold and/or trauma. Given the patient’s history of motor vehicle accident 3 months prior with concurrent neck strain injury, the etiology of lipogranuloma is this case is likely due to endogenous lipid degeneration. Conclusion : This case reports the rare clinical finding of a patient with lipogranuloma likely secondary to endogenous inflammatory lipid degeneration.

The term chalazion, from the Greek meaning ‘hailstone’, refers to a lipogranuloma of the meibomian gland. Chalazia are very common and the majority can be managed conservatively in primary care. This review provides an overview of management for GPs.

Mesenteric panniculitis (also known as mesenteric manifestation of Weber–Christian disease, isolated lipodystrophy and mesenteric lipogranuloma), a benign inflammatory or fibrotic change in the mesentery of the bowel, is a rare diagnosis, particularly in the UK. Some 213 cases have been reported in the world-wide literature, just six from the UK. We present four cases of mesenteric panniculitis in Merseyside and review the literature surrounding this poorly understood phenomenon. Four patients who attended surgical out-patients with vague abdominal symptoms, and in two cases a palpable mass, were sent for abdominal computed tomography (CT) scan. One patient was admitted as an emergency with abdominal pain. In each patient there were clear signs of mesenteric panniculitis, first described in 1924. The ’classical’ signs of mesenteric panniculitis seen on CT have been argued by some to be pathognemonic of the disease. In two cases, the patients underwent laparoscopic biopsies to confirm the diagnosis. We discuss the literature relating to mesenteric panniculitis, theories about its aetiology, confirmation of the diagnosis and consider the possibility that it is not actually as rare as we think. We suggest that it is rather under diagnosed due to the relative ignorance of the condition amongst both surgeons and radiologists the UK compared to the US, where mesenteric panniculitis is far more widely reported.

— Portal lipogranulomas in liver biopsy specimens were investigated. The incidence of biopsies containing portal lipogranulomas was 2.4%. Out of 20 biopsies with lipogranulomas 10 biopsies contained only one lipogranuloma. Portal lipogranulomas show a distinctive morphology with fat vacuoles surrounded by macrophages. They are consistently found together with parenchymal steatosis and probably originate from parenchymal fat being transported to portal tracts. Portal lipogranulomas are of importance in the differential diagnosis from other granulomas.

This report presents a case of Lipogranuloma of lower lip in an 8-year-old boy. The patient has been noticed a painless swelling on his lower lip for about three months. He had a past history of repeated rupture of the lesion, and the lesion currently presented with a soft and nodular mass at the left lower lip. The clinical diagnosis was lipoma. Histopathological examination of the surgically removed specimen revealed a number of fat-like globular material infiltrating into the submucosal tissues including skeletal muscle and atrophic minor salivary gland. A granulomatous inflammation with macrophages was noted over the lipidic infiltration, leading to a final diagnosis of ‘lipogranuloma of foreign body type arising in collapsed mucous cyst'. The lesion was induced by repeating administration of Castor oil on the collapsed mucous cyst in the region. In the present report, we describe a case of lipogranuloma arising in the collapsed mucous cyst caused by Castor oil application, which were very rare of maxillofacial region.

In this retrospective study, the medical records of 23 dogs with the sonographic feature of small intestinal hyperechoic mucosal striations and an endoscopic or surgical intestinal biopsy were reviewed. Histopathologic lacteal dilation was present in 96% of dogs with mucosal striations. Sonographic findings associated with mucosal striations included: mild jejunal wall thickening (96%), mild duodenal wall thickening (78%), mucosal speckles (70%), and abdominal effusion (87%). The mucosal striations were diffuse (70%) or multifocal (30%) and did not cause loss of wall layering, except in one dog with a severe mural lipogranuloma. Mesenteric lymphadenopathy was identified in 9% of dogs. Thirteen dogs with endoscopic biopsies had mild to moderate villus lacteal dilation and the nine dogs with surgical biopsies had moderate to severe dilation. Inflammatory infiltrates were mild (61%) or moderate (30%) with variable numbers and combinations of cells, including eosinophils (65%), plasma cells (61%), lymphocytes (57%), and neutrophils (30%); one dog had disseminated villus histiocytic sarcoma. The biochemistry changes and clinical signs were consistent with protein-losing enteropathy in 78% of dogs. Hyperechoic mucosal striations in dogs are associated with lacteal dilation and are frequently associated with mucosal inflammation and protein losing enteropathy.

Periorbital lipogranuloma following autologous fat injection into the forehead for cosmetic facial augmentation is a recently described adverse outcome. Patients have typically been treated with surgical excision. This study evaluates the clinical characteristics of periorbital lipogranulomas, and the non-surgical treatment outcomes of these patients. This is a noncomparative, interventional case series. A retrospective analysis of clinical data and radiographic images was performed of patients with periorbital lipogranuloma following autologous fat injection. Objective treatment outcomes after intralesional triamcinolone injection and/or oral prednisolone were evaluated by measuring the size of the lipogranulomas pre- and post-treatment. Cosmetic outcomes were also assessed by the subjective satisfaction at the last visit. Twenty-seven patients were identified with periorbital lipogranuloma following facial autologous fat injection. All patients were female, the mean age was 40 ± 10 years, and 19 patients received cryopreserved fat. Twenty-one patients underwent non-surgical corticosteroid treatment. ‘Resolution’ was achieved in 15 patients (71 %), and ‘Partial Resolution’ was achieved in 5 patients (24 %). One patient (5 %) who took oral prednisone alone showed ‘No Response’. Cosmetic outcomes were classified as ‘Very Satisfied’ in 16 patients (76 %), ‘Satisfied’ in 4 patients (19 %), and ‘Dissatisfied’ in 1 patient (5 %) after corticosteroid treatment. Periorbital lipogranuloma following autologous fat injection may be diagnosed by history, physical exam, and orbital imaging. Non-surgical corticosteroid treatments showed a good response with few adverse effects and should be considered as a first line of treatment of periorbital granulomas prior to conducting surgical excision. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An eyelid or orbital lipogranuloma can occur following nasal packing with liquid paraffin, petroleum jelly or an antibiotic-based cream. It usually presents a few weeks or months after the initial procedure. We present a report of three such cases of sclerosing lipogranuloma involving the eyelid, which occurred following a sinonasal surgery where nasal packing using petroleum jelly was performed. The typical clinical course and the classical histopathological features are highlighted. All cases were diagnosed by histopathological examination as sclerosing lipogranuloma. Complete surgical removal resulted in complete resolution on 1 month follow-up. The diagnosis is based on a high degree of suspicion following a detailed history of prior use of lipid-based products for nasal packing following endonasal surgery. Histopathology is diagnostic. Surgical excision is the treatment of choice, however, due to its infiltrative nature, it may be difficult to obtain a complete cure.

A few cases of subcutaneous nodules with the histological findings of membranous lipodystrophy-like changes have been reported in the literature. However, reports of membranous lipodystrophy-like changes caused by trauma are exceedingly rare. We report two cases of traumatic lipogranuloma that had linear and multiple lesions showing membranous lipodystrophy-like changes and were induced by safety belt trauma after a car accident. These patients showed peculiar changes in their subcutaneous fat and had linear patterned, multiple, nodular lesions with membranous lipodystrophy-like changes caused by trauma.

Background Penile paraffinoma is a well-known delayed complication of paraffin oil injection into the penis for penile girth augmentation but its MRI features have not been previously described. Case presentation A 35-year-old Ukraine man presented with erectile dysfunction, voiding difficulty and an irregular, hard and painful penile mass that had progressively grown over the last year. He reported having received, seven years before, several penile injections of paraffin oil for penile girth augmentation. On physical examination, the mass was tender, poorly delimited, and involved the whole penile shaft and the cranial part of the scrotum. Preoperative MRI, performed to determine the extent of tissue to be removed and the possibilities of penile reconstruction, showed a newly-formed homogeneous tissue, compressing but not infiltrating Buck’s fascia, iso-hypointense relative to muscle on T1-weighted sequences, and with a low signal intensity at T2-weighted sequences. On T1-weighted fat suppressed sequences, it did not enhance with contrast administration. MRI data were confirmed by surgical findings, as the newly-formed scar tissue did not infiltrate Buck’s fascia. Pathology confirmed the diagnosis of penile paraffinoma. Conclusion MRI seems to provide an adequate imaging of the histological events occurring after injection of paraffin oil in the subcutaneous tissues. Penile paraffinoma remains a clinical diagnosis, but MRI features may be helpful in planning an adequate surgical strategy and, in selected cases, establishing the differential diagnosis with other penile diseases, including cancer.

Background: Chronic lipogranuloma of anterior orbit and the eyelids is a rare inflammatory pseudotumor with a high tendency of recurrence. It is most commonly related to prior endonasal sinus surgery. History and signs: We report on three patients with chronic lipogranulomata who were treated at the university eye-hospital of Dusseldorf during the last 8 years. These cases are discussed individually and longterm results are presented. Therapy and outcome: Three patients underwent endonasal surgery with postsurgical use of paraffin nasal packing prior to the occurrence of chronic lipogranulomata. Histologic findings uniformly revealed granulomatous processes but in none was there any sign of a systemic granulomatous disorder (such as Boeck's disease). Additionally, one of these three patients suffered from neuroophthalmologic impairment due to infiltration of oculomotore structures. Early surgical treatment if only for extended biopsy did result in immediate severe recurrence of the disease. No recurrence of the disease has been observed, however, if surgery was duely postponed. Conclusions: Lipogranulomata seem to be caused by postsurgical paraffin nasal packing. Early treatment seems to be unfavourable because of the high tendency of recurrence. Surgical removal of any tumor masses should be delayed therefore till granuloma formation has presumably come to an end. Any early surgery should be limited to a diagnostic biopsy if judged necessary.

We report on a rare manifestation of Erdheim-Chester disease with intramuscular lipogranuloma. The patient was a 66-year-old man who noted a soft tissue mass in the right quadriceps femoris muscle. Radiographs revealed symmetrical osteosclerosis in the diametaphysis of both femora and tibiae. An open biopsy revealed a proliferation of lipid-laden histiocytes in the femoral bone marrow and the quadriceps femoris muscle. To our knowledge, this is the second case of Erdheim-Chester disease involving muscle.

Myospherulosis or lipogranuloma formation is frequently iatrogenic and is caused by a petrolatum, lanolin, or paraffin-based ointment becoming trapped within tissue. Four different ointments, including the newly available Bactroban nasal, were studied in a rabbit paranasal sinus model to evaluate their proclivity to induce myospherulosis. The maxillary sinuses of 16 New Zealand white rabbits were bilaterally inoculated with Bactroban, Bactroban nasal, tetracycline, or bacitracin ointments and compared to saline controls in two rabbits. Sinus specimens were harvested at 2 and 4-week intervals and processed for histologic study. Myospherulosis formation was uniformly induced with the Bactroban nasal, bacitracin, and tetracycline ointments in 8/8, 7/8, and 8/8 sinuses, respectively. In contrast, myospherulosis was not induced in the 5/8 of the sinuses using Bactroban. The data from this investigation indicate that Bactroban nasal (paraffin vehicle) is similar to bacitracin and tetracycline ointments (petrolatum and petrolatum-lanolin vehicles) in that they all can cause myospherulosis. In contrast, Bactroban (a water-soluble, polyethylene glycol base) causes myospherulosis to a much smaller extent. Our results emphasize the differences between the two types of Bactroban preparations and provide objective data that can be evaluated by otolaryngologists who apply these ointments following nasal cavity surgery.

Eine 60jahrige Patientin mit periorbitalem Lipogranulom nach endonasaler Nebenhohlenoperation wird vorgestellt. Ausgangspunkt fur die granulomatose Entzundung bilden nichtresorbierbare Lipide, die aus der postoperativ angelegten Nasentamponade stammen und mit dem operativ bedingten Hamatom in das Periorbitalgewebe gelangen. Der Verlauf dieses Entzundungsprozesses ist chronisch. Die moglichst vollstandige Ausraumung ist anzustreben.

BACKGROUND Paraffin is a mineral oil which was discovered by Reichenbach in 1830. Injection of paraffin into tissue causes a foreign body reaction that results in the formation of a paraffinoma. METHODS We are reporting on two cases of paranasal paraffinomas, in a 30-year-old male three months after a septorhinoplasty in which paraffin nasal packing was used and in a 56-year-old female patient two months after sinus surgery. RESULTS A paraffinoma is probably caused by penetration of paraffin through a mucous membrane defect into the adjacent soft tissue. Paraffinomas are usually treated by excision. Although recurrences are frequent, a complete removal should be attempted because of the potential carcinogenicity of paraffin. CONCLUSION Paraffinomas must be considered in the differential diagnosis of periorbital or paranasal swellings that occur months after endonasal procedures where paraffin packing was used.

A 76-year-old woman underwent a left nephrectomy for a retroperitoneal angiomyolipoma, which was contacting and displacing the spleen and left kidney. Intraoperative frozen sections of a periportal lymph node revealed brown pigment within the sinuses. Permanent sections of this specimen demonstrated a reactive lymph node with lipogranuloma formation, prominent histiocytes, and ovoid, dark-brown to yellow structures located within the sinuses, associated with the prominent histiocytes. These structures ranged from 0.25–1.0 times the size of a lymphocyte nucleus and were primarily extracellular, with only occasional examples noted within histiocytes. A 55-year-old man underwent a right hemicolectomy for a tubulovillous adenoma of the ascending colon. Preoperative CT scan revealed mildly enlarged retroperitoneal lymphadenopathy, but no other evidence of metastasis. Eleven lymph nodes were located within the pericolic adipose tissue of the specimen, all negative for malignancy. Three of the eleven nodes demonstrated ovoid, dark-brown structures within the subcapsular sinuses, as …

The cosmetic injection of exogenous lipids and more recently of polydimethyl siloxane (injectable silicone) into the scrotum has been described since 1899. Sclerosing lipogranuloma and paraffinoma are terms applied to a complication of this practice in which the injected oils or silicone elicit a marked granulomatous reaction with prominent surrounding fibrosis. Although this complication has been described as a localized process occurring mainly in the scrotal area and regional lymph nodes, few studies have documented systemic manifestations. In this report we describe the autopsy findings of a 48-year-old man who had scrotal and systemic lipogranulomas from repeated self-administered injection of mineral oil. In addition, severe acute pulmonary edema resulted in sudden unexpected death. To our knowledge, this fatal complication of exogenous lipogranuloma has not been previously reported. Language: en

Objectives The authors aimed to report 5 cases of patients with penile lipogranuloma–induced full necrosis of penile skin, wherein they obtained good results from simultaneous implementation of Y-V incision to prevent the shortening of penile length together with bipedicular scrotal flap. Methods The full excision of penile lipogranuloma and a bipedicled scrotal flap was performed. After finishing the scrotal flap, for extension in length, the authors performed the inverted V incision on the upper skin of followed by partial resection of suspensory ligament and sutured up to subcutaneous tissue in the inverted Y shape, extending the dorsal portion skin toward the penis. Results There was no shortening in length of the penis or reduction in girth and the resulting penis had no difference to normal skin of penis, with almost no contraction of the scrotum, and all patients were satisfied with the visual postoperative shape of the penis. Conclusions The authors had performed a complete excision of paraffinoma in patients with penile paraffinoma with concurrent skin necrosis and obtained good outcomes of preventing the shortening of penile length by performing a bipedicled scrotal flap with Y-V incision using the scrotal skin.

Background Penile self-injection of various oils is still carried out among Eastern Europe people for penile girth augmentation despite the potential destructive complications of this practice are well known. Penile reactions to such foreign bodies include scarring, abscess formation, ulceration, and even Fournier’s gangrene; voiding problems due to mineral oil self-injection have been reported only once. To our knowledge, we describe the first case of paraffin self-injection for penile girth augmentation presenting with acute urinary retention. Case presentation A 27-year-old Romanian man presented with severe penile pain and acute urinary retention five years after having practiced repeated penile self-injections of paraffin for penile girth augmentation. The penile shaft was massively enlarged, fibrotic and phymotic; urethral catheterization failed due to severe stricture of the proximal pendulum urethra. The patients refused placement of a suprapubic catheter and underwent immediate penile surgical exploration. The scarred tissue between dartos and Buck’s fascia and a fibrotic ring occluding the urethra were removed and the penile skin reconstructed. Pathology confirmed the diagnosis of paraffinoma. The patient resumed normal voiding immediately after catheter removal on second postoperative day; he was very pleased with cosmetic, sexual and voiding results at six weeks, six months and 1 year follow-up. Conclusions The present report describes a novel complication of penile self-injection for penile girth augmentation. Because of the increasing number of patients seeking penile augmentation, physicians dealing with sexual medicine should pay more attention to such request to prevent the use of non medical treatments that can turn into medical disasters.

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.

We report a case of a huge cystic lipogranuloma of the retroperitoneal cavity in a 64-year-old man. The only clinical symptoms consisted of loss of appetite, increase of the abdominal girth and painfu

We report on an instructive case of an infrequent but severe complication after paranasal sinus surgery. The use of ointment-covered nasal packing for haemostasis can cause inoculation of ointment into the orbita, if the medical orbital wall has been injured intraoperatively. A postoperative intraorbital haematoma may spread ointment droplets into subcutaneous tissues of the eyelid and cause local sclerosing lipogranulomatosis. The case reported here underlines the resulting therapeutical problems as have been mentioned in the literature. Only complete excision of the lipogranuloma can prevent recurrences. We conclude that ointment should not be used with nasal packings after paranasal sinus surgery if an intraoperative lesion of the orbital wall is likely to occur.