title: Granulomatous lymphangitis of the scrotum and penis. Report of a case and review of the literature of genital swelling with sarcoidal granulomatous inflammation.
abstract: 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.
authors.affiliation: Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Murphy
authors.forename: B
authors.initials: B
authors.lastname: Kogan
authors.forename: J A
authors.initials: JA
authors.lastname: Carlson
mesh_terms: D000287:Administration, Topical; D002648:Child; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006099:Granuloma / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008205:Lymphangitis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D008209:Lymphedema / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D008297:Male; D010409:Penile Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D012611:Scrotum / Q000473:pathology*; D012871:Skin Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids