Sclerosing Lipogranuloma

Abstract

In 1950, Semetena and Bernhard1 reported 14 cases of subcutaneous lipogranuloma; they used the term "sclerosing lipogranuloma" as a descriptive name. They felt that these cases, in which the process was localized and frequently followed trauma, could be separated from other recognized entities, such as Weber-Christian disease, traumatic fat necrosis of the female breast, adiponecrosis subcutanea neonatorum, and changes in the lung following aspirations of oils and fats. This separation was accomplished by showing differences in clinical features of the diseases and occasionally by histological features in the tissues.Spencer,2 in 1949, described a case of "fat necrosis" of the omentum that followed a blunt injury to the abdomen. In this patient, there was a mass in the left lower quadrant simulating carcinoma of the colon. This mass was resected and was similar histologically to the lesions described by Smetana and Bernhard.1 The lesion did not recur. We will now discuss two additional cases; the first involves the scrotum, penis, and abdominal wall, and the second involves a pelvic lipogranuloma that developed after repeated pelvic laparotomies. REPORT OF CASESCase 1.-A 52-year-old white man had learned to aspirate a left-sided hydrocele that he had noted for about 25 years. He carried out this procedure three or four times each year. In November, 1950, after aspiration of the hydrocele, soreness in the scrotum developed, and a large mass quickly formed. The left testicle was removed, but the mass remained. Early in 1951, this process extended over the abdominal wall as high as the nipple line. Biopsy reports were consistent with Weber-Christian disease, but the patient had no fever. A course of x-ray therapy resulted in little or no improvement.In August, 1951, this patient came under the observation of one of us (B. T. G.). Examination revealed recent weight loss and a large, nonfluctuant, nontender, scrotal mass measuring 20 by 12 by 12 cm. (fig. 1). Over the anterior abdominal wall were large, irregular, subcutaneous, firm, slightly tender, contiguous masses. There was no increase in local temperature in the area of these lesions. In some areas the skin was fixed to the underlying subcutaneous fat, and the tissues were inelastic. This kept the patient at bed rest most of the time. Laboratory studies revealed nothing remarkable.Biopsy of the scrotal mass was read as consistent with sclerosing lipogranuloma. The patient was treated with cortisone (300 mg. the first day, 200 mg. the second day, and 100 mg. each day thereafter) for about one month without complications. Within a week, there was striking objective improvement in the lesions. The induration of the upper abdominal wall was markedly reduced, and the skin became softer and more pliable. There was less improvement over the lower abdominal wall, and the scrotal mass was not affected. Subjective improvement was even more striking. The patient's appetite became voracious, and he was ambulatory most of the day.When cortisone dosage was reduced to 50 mg. d...

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura

“…Debe aclararse que también se han reportado casos de LGE en pacientes que niegan la aplicación de dichas sustancias, por lo que a pesar de no existir causas bien determinadas, se ha visto relacionado con degeneración de grasa endógena idiopática en pacientes con antecedente de trauma 8 (ejercicio intenso, equitación, bicicleta), infecciones, temperaturas extremas o reacciones alérgicas, denominándose LGE primario 3,6 . Su fisiopatología, sea primaria o secundaria, se ha visto relacionada con una reacción inflamatoria en el tejido graso, con la subsecuente degeneración lipídica y la formación de tejido granulomatoso 3 .…”