Extensive lymphatic malformation of penis and scrotum

Penile Chylorrhea as a Rare Presentation of Penile Lymphangioma Circumscriptum Reconstructed with Deep External Pudendal Artery Perforator Flap

Chylorrhea, a chylous (white viscid) discharge from the external urethral penile opening, is unrelated to urination and is a rare presentation of lymphangioma circumscriptum in the penis that can significantly impair a patient’s quality of life and psychological well-being. Herein, we present a case of recurrent chylorrhea that was detected using diagnostic tools and treated using the deep external pudendal artery perforator flap in the inner thigh, which is extremely rich in lymphatic vessels and lymph nodes.

Penile Lymphangioma: review of the literature with a case presentation

Background

Penile lymphangiomas are rare manifestations of lymphangiomas or lymphatic malformations which are more commonly found in the head or neck region of the body. Lymphangiomas are further categorized as lymphangioma circumscriptum, cavernous lymphangioma, cystic hygroma, or acquired lymphangiomas (also known as lymphangiectasia), based on their depth and etiology.

Results

A literature review revealed only 30 cases of penile lymphangioma between 1947 and March 30, 2018. Several causes were attributed to the acquired penile lymphangiomas, including trauma, phimosis, and infection. While penile lymphangiomas can be initially mistaken for an infection, a thorough history and physical examination is sufficient to clinically diagnose a lymphangioma of the penis. Historically, surgical excision has been the gold standard of treatment for this condition. When asymptomatic, patients may opt for conservative management with avoidance of mechanical trauma alone. Other physicians have revealed novel treatment plans to rid patients of their penile lymphangioma such as a staged laser procedure.

Conclusion

In this article, we elucidate the causes, symptoms, treatments, and outcomes associated with penile lymphangiomas found in the literature while also presenting the case of a 30-year-old African-American man diagnosed with acquired penile lymphangioma.

The effect of scrotal reconstruction with skin flaps and skin grafts on testicular function

Due to its unique composition, the reconstruction of scrotal skin defects is a major clinical challenge. This study was designed to evaluate the effects of scrotal reconstruction, using skin grafts and skin flaps, on spermatogenesis. In Group 1, the rats did not undergo surgery and were used as controls. In Group 2, after removal of all of the scrotal skin to expose the testicles, the defect was repaired using a skin flap from the right groin region. In Group 3, the reconstruction was achieved using skin grafts. All the rats were killed at 2 months postoperatively and evaluated. The mean wet weights of the testicles in the control group were significantly higher compared with that of the graft group. The mean height of the germinal epithelium was significantly greater in the control and flap groups compared with that of the graft group. The Johnsen score for spermatogenesis in the control group was higher than that in the graft group. The use of flaps resulted in testicular function that was comparable to that of the control group, whereas the use of grafts resulted in diminished testicular function. Therefore, we suggest that flaps may be the first choice for scrotal reconstruction.

Genital lymphangioma with recurrent cellulitis in men

BACKGROUND

Lymphangioma circumscriptum rarely occurs on the penis. This report describes a patient observed in private practice who presented with recurrent unexplained cellulitis of the penis for whom this diagnosis was not initially apparent.

METHODS

Diagnosis of lymphangioma in this patient resulted in a retrospective records review of the Mayo Clinic experience with patients who had genital lymphangioma and cellulitis.

RESULTS

Six other male patients with recurrent cellulitis complicating genital lymphangioma were identified. Five of these six patients were managed with antibiotic prophylaxis.

CONCLUSIONS

Compromised lymphatic drainage should be suspected in male patients with otherwise unexplained penile swelling or cellulitis. These patients usually require long-term antibiotic prophylaxis for recurrent infection.

Lymphangioma of the penis: a rare anomaly

Lymphatic malformations are known to affect any part of the body. However, lymphangiomas involving the penile skin are rare. We report a case of a cutaneous lymphatic malformation of the penis.