In this forensic case report, we present autopsy findings from a young male in his thirties who had been self-injecting paraffin oil into his upper extremities 8 years prior to death. The injections induced an inflammatory response, leading to granuloma formation. This, in turn, resulted in severe hypercalcemia. The external autopsy examination revealed gross macroscopic ulcerations and enlargement of upper extremities, while calcifications of ligaments, heart, kidneys and dura mater was revealed on postmortem CT-scans. Histopathological examination showed extensive multiorgan metastatic calcifications in several tissues including the lungs, heart and kidney. Cause of death was estimated to be the extensive calcific deposits in the heart likely resulting in cardiac arrest. To our knowledge this is the first case reporting findings from an autopsy in which the cause of death was linked to cosmetic oil injections.

Leprosy is a chronic infection in humans that mainly affects the peripheral nerves and skin. Paraffin filling has been previously used for muscle atrophy treatment. However, the formation of paraffin granulomas (paraffinomas) can occur over the long term. We encountered a patient with leprosy who had hypothenar muscle atrophy caused by ulnar neuropathy. The patient was treated with paraffin injection at the hypothenar site for cosmetic appearance 60 years ago. Consequently, the paraffin formed a paraffinoma and a recurrent infected skin ulcer. Thus, paraffinoma removal and transfer of ulnar artery perforator adiposal flap (140 × 20 mm) were performed. The ulnar artery perforator adiposal flap was used for infection control and filling the dead space after paraffin removal. The skin healed without complications. Ultrasound confirmed residual adipose tissue and blood flow at the last follow-up.

Penile paraffinoma or sclerosing lipogranuloma is a disease occurring uncommonly in Czechia; a pathologist meets this only rarely. Microscopically, we deal with chronic fibroproductive inflammation localised usually in subcutaneous tissue of the penis. It is caused by previous voluntary injection of liquid paraffin / mineral oil for the purpose of penis circumference augmentation, usually performed by a non-healthcare person or by the patient himself. Human tissues do not have enzymes that can break down synthetic lipids. The application leads, with a variable time lag, to a foreign body giant-cell reaction lasting for years, and often to annoying complications frequently associated with a genital mutilation and sexual dysfunction. The lesion often requires surgical treatment to remove the paraffin substance from the subcutaneous tissue. The surgery does not always lead to satisfying results and the paraffinoma tends to recur. In this article, we describe a case of a man with relapsing paraffinoma, which required excision of subcutis with subsequent plastic surgery with skin graft. During histological examination, lipid droplets were found in dermis and in subcutis, along with xantogranulomatous inflammation. The lipid nature of the material was proven by oil red and Sudan stain. The paper includes clinical and histopathological differential diagnostic consideration, summary of treatment options and relevant literature review.

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.

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.
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.
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.
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.
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.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

BACKGROUND: The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed.
METHODS: A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period.
RESULTS: We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis.
CONCLUSIONS: Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

BACKGROUND: Penile paraffinomas are a consequence of an injection of mineral oils for augmentation. As an result of the foreign body reaction local complications regularly occur, which require a plastic reconstructive intervention. So far 8 cases have been treated in our clinic over the last 20 years.
OBJECTIVE: Presentation of the operative treatment techniques for penile paraffinoma as well as the indications and complications.
METHODS: After reviewing the relevant literature, we analyzed the data of our own patient cohort. Since 1999 a total of 8 patients with lipogranuloma underwent surgical treatment at the St. Antonius Hospital in Eschweiler.
RESULTS: The choice of a plastic reconstructive treatment depends on the extent of the paraffinoma. If it is limited to the foreskin, a radical circumcision is sufficient but if it extends to the skin of the penile shaft, a plastic defect coverage with a mesh graft, a full skin graft or a scrotal skin flap is required. In cases with additional pathologies, such as urethral fistulas, auxiliary reconstructive procedures should be performed.
CONCLUSIONS: For optimal cosmetic and functional results, the surgeon must master a broad spectrum of plastic reconstructive techniques. In selected complex cases an interdisciplinary approach consisting of urologists and plastic surgeons can be necessary.

暂无摘要。

Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma. A systematic search of PubMed and Scopus was performed with 10 case series and 26 case reports identified between 1956 and 2017. A total of 124 cases, with a mean age of 36.29 yr, were identified. The majority originated in Korea, and the most common injected material was liquid paraffin (80.6%). Patients presented with pain/swelling, ulceration/fistulae, and penile deformity. The majority required surgical excision of paraffinoma followed by reconstruction with a variety of procedures including split skin grafting, scrotal skin flap reconstruction, and prepuce grafting. Mean duration of follow-up was 15.8 mo. Penile paraffinoma remains a rare presentation; however, it can present management difficulties. We have had an increase in cases, with three patients presenting with complications following injection of paraffin in our unit in the past 2 yr. Definitive management includes surgical excision and reconstruction as required with early involvement of plastic surgeons. There may be a role for conservative management; however, long-term outcomes are unclear. There may be a need for targeted preventative measures through public health agencies in communities where the practice is more prevalent. PATIENT SUMMARY: Penile paraffinoma can occur following injection of liquid paraffin or similar substances, generally used by non-healthcare personnel for the purpose of penile augmentations, and can cause significant pain, ulceration, and penile deformity. Definitive management includes surgical excision with reconstruction as required. Prevention of its use through awareness and education may be required in communities where the practice is more common.

The purpose of this study was to present our series of patients with disastrous consequences of failed penile self-augmentation and suggested surgical reconstruction. Ten patients with median age of 23 years and a variety of penile and scrotal deformities due to injections of several substances had undergone successful surgical reconstruction of external genitalia. The injections were self-performed in nine cases and the patients reported from 4 to 20 substance injections throughout the penile shaft. Three patients presented with fibrotic scirrhous masses in their scrotum, although they did not report any injections in scrotal area. All patients underwent extended penile-shaft skin excision, while all palpable scrotal lesions were removed in one-by-one fashion, as an attempt to destroy the less possible scrotal tissue. All patients were discharged on first post-operative day and reassessed at 2 months post-operatively. As a result, penile self-augmentation with injected substances may cause severe complications. Our proposed single-staged procedure seems safe and effective.