Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia

Abstract

Chronic granulomatous inflammation may develop after injecting foreign oily substances into the penis. The disorder affects mainly the site of administration, but regional lymphadenopathy or even systemic disease can occur. We present a 39-year-old man with petroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient's history, physical and histopathological examination are required to establish the diagnosis.

Fig. 1

Penile deformity firm on palpation due to injection of petroleum jelly 3 years prior to presentation.

Fig. 2

Cut surface of one of the lymph nodes removed during surgery suspicious for malignancy.

Fig. 3

Foreign material induced granulomatous lymphadenitis consistent with paraffinoma of the lymph node. The white vacuoles represent the oily material after tissue processing. Paler pink areas among dark lymphocytic fields reflect the granuloma forming histiocytic reaction with epithelioid histiocytes, Langhans type giant cells (not clearly discernible at this magnification), multivacuolated phagocytes (short arrows) and multinucleated foreign body type giant cells engulfing the oily material in larger vacuoles (long arrows); Hematoxylin and eosin ×100.