Sclerosing lipogranuloma of the genitalia treated with corticosteroids Nathan Lawrentschuk, David Angus & Damien M Bolton Departments of Surgery and Urology, University of Melbourne, Austin Hospital, Studley Road, 3084, Heidelberg, Victoria, Australia Abstract. Primary sclerosing lipogranuloma is an unusual benign condition of the genitalia typically pre- senting as a painless mass affecting the penis and scrotum. Its importance lies in differentiating it from malignancy to avoid extensive surgery. It is normally treated with total or partial excision. This is the first reported case where oral corticosteroids have been used to treat this condition whereby a six-week course resulted in the mass disappearing. In conclusion, if sclerosing lipogranuloma is suspected biopsy should be undertaken to exclude sarcoma. We believe surgery should be reserved for recurrent or refractory cases when steroids have failed as first-line treatment. Key words: Adipose tissue, Genital neoplasms, Male, Sclerosis, Steroids Introduction Primary sclerosing lipogranuloma is an unusual benign condition of the genitalia usually present- ing as a painless, often ‘Y-shaped’ mass affecting the penis and median raphe of the scrotum. It is associated with eosinophilia, may spontaneously regress after partial resection and typically does not recur [1, 2]. Its importance lies in differentiat- ing it from malignancy to avoid extensive surgery [2]. The secondary form of sclerosing lipogranu- loma is typically painful and follows injections into the genitals with exogenous lipids in an effort to enhance sexual potency [1]. This is the first re- ported case where oral corticosteroids have been used to treat this condition. Case report A 43-year-old male presented with a two-month history of a painless lump increasing in size at the base of his penis. He was otherwise asymptomatic and had no past medical history. On examination a lesion was apparent at the dorsal base of the penis (Figure 1) approximately 2.5 cm wide with its depth unable to be ascertained. The rest of the examination was unremarkable. Core biopsies were organised to exclude a sar- coma. Histological examination found fibrous tis- sue with lipid spaces, necrotic fat, clusters of multinucleated giant cells and an inflammatory infiltrate of lymphocytes and macrophages, with prominent eosinophils consistent with sclerosing lipogranuloma (Figure 1). Full blood examination was normal apart from a mild eosinophilia (0.48; normal <0.4 · 10 9 l )1 ). Other inflammatory mar- kers (erythrocyte sedimentation rate and c-reactive protein) were normal. A magnetic resonance imag- ing (MRI) scan revealed a soft tissue mass imme- diately superior to the root of the penis consistent with a benign soft tissue mass (Figure 2). The patient declined any surgical intervention and considering the literature, a decision to pursue a conservative course appeared reasonable. A six- week course of oral prednisolone (20 mg/day) was commenced due to the inflammatory nature of the condition. After the course of steroids, the mass had completely disappeared and at 3 months his eosinophilia had resolved. International Urology and Nephrology (2006) 38:97–99 Ó Springer 2006 DOI 10.1007/s11255-005-8572-5