Subcutaneous nodule on the scrotum

Abstract

A 56-year-old man, who was in otherwise good health, came to our clinic with a one-year history of a slow-growing, pruritic subcutaneous nodule on the scrotum. There was no history of trauma. Two years earlier, he had travelled to southeastern Africa, where he had gone swimming in Lake Malawi. Skin findingsOn the right side of the scrotum there was a 1 cm large nodule, which was barely visible, but was palpable and markedly indurated; there was no ulceration or discharge (Figure 1a). His skin was otherwise normal and he had no lymphadenopathy. HistologyThe epidermis was acanthotic. Throughout the entire dermis and extending into the subcutaneous fatty tissue were granulomas with central necrobiotic areas; these were surrounded by a dense lymphohistiocytic infiltrate with abundant eosinophilic granulocytes and multinucleated giant cells (Figure 1b, c). Upon further examination of the tissue sections, the granulomas contained anisotropic cystic structures with PAS-positive walls and intraluminal round globuli which were basophilic (Figure 1d).