Paraffinoma of the penis

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Classification according to ICD-10
M60.2 Foreign body granuloma in soft tissue, not elsewhere classified
ICD-10 online (WHO version 2019)
A penis with a paraffinoma caused by the intraurethral injection of liquid paraffin (30-year-old patient). In the lower left corner of the picture is a finger of the examining doctor.

The paraffinoma of the penis is a special type of sclerosing lipogranuloma in the area of ​​the penis . The paraffinoma of the penis has exclusively exogenous causes and, if left untreated, has an extremely poor prognosis .

Epidemiology and etiology

At the beginning of the 20th century, the injection of paraffins or mineral oils under the skin of the penis was a widespread practice for penis enlargement in Europe . Many years later, after the undesirable side effects gradually became known, this technique largely disappeared in Western Europe . In many Eastern European countries and Korea it is still practiced today.

This form of penis enlargement is currently performed almost exclusively by non-medical professionals. In a study published in 1996 of 26 Korean patients between 1981 and 1993, the mean age of the patients was 39.6 years, with the age interval ranging from 19 to 77 years. The main reasons given by the patients for treatment were: the desire for a larger penis (14), erectile dysfunction (7), and the desire to be able to satisfy their sexual partner (5 patients). In only two cases (satisfaction of the sexual partner), the injections also fulfilled the wishes of the affected person. After an average of 18.5 months, the penis in the area of ​​the injection sites became painful in 19 of the 26 patients. The remaining seven patients were painless, but complained about discoloration of the penile skin and a change in penile geometry. The lipogranulomas ulcerated in 17 of the 19 patients , with occasional purulent discharges. The injected paraffins or mineral oils remained fixed on the area of ​​the penis. Diffusion into other organs was not observed.

In another study, 357 Korean men were asked about the outcome of injecting paraffin into their penis. 91 percent were not satisfied with the result of the injection, 74 percent would like to have the injected material removed and only 15.6 percent had no side effects. In contrast, the majority complained of inflammation , skin necrosis and pain .

In most cases it takes at least a year from the first injection of the liquid to the onset of the paraffinoma; in individual cases, almost 40 years can pass.

pathology

→ see main article lipid granuloma

The subcutaneous injection of non-absorbable liquids into the penis - but also generally into other areas of the body - can lead to a foreign body reaction , which results in the formation of a foreign body granuloma. A foreign body granuloma is a non- infectious granuloma . This is a nodal formation of new tissue , consisting of epithelial cells , mononuclear cells or giant cells that wrap around the foreign body and encapsulate it. The lipid granulomas arise as a result of a non-specific immune response of the organism.

therapy

A paraffinoma of the penis should be treated in any case, since in most cases the disease has a progressive , i.e. steadily worsening course.

The method of choice is complete removal of the penile foreskin ( circumcision ) and radical excision (“cutting out”) of the paraffinoma. If the paraffinomas are not completely removed, they can recur after removal . In many cases, a phalloplasty , i.e. a reconstruction of the penis from the body's own tissue, is necessary.

If the patient does not consent to surgical removal of the paraffinoma or if the course is less severe, conservative treatment can also be used. It is essentially symptomatic, through repeated injections of glucocorticoids such as triamcinolone directly into the paraffinoma. Long-term results on this form of therapy are not available. Oral corticosteroids are also an option. Some authors recommend this as a first-line therapy and surgical removal of the paraffinoma only if this form of therapy does not respond.

Especially in elderly patients with ulcerating lesions of the penis, there is a risk that the chronically inflamed tissue will develop into a squamous cell carcinoma .

Medical history

Robert Gersuny (1844–1924) first used paraffin for a testicular prosthesis in 1899 - a mistake with grave consequences, as it was only discovered decades later.

The Austrian surgeon Robert Gersuny first reported in 1903 about the use of paraffin as a testicular prosthesis . In 1899, he injected paraffin into a patient who - as a result of tubercular orchitis - had to have both testicles removed ( orchiectomy ). Encouraged by the (short-term) success of his reconstruction, Gersuny and a number of colleagues around the world began injecting various mineral oils and paraffins into different regions of the body; for example for the treatment of deformations of the face , hemorrhoids , incontinence , hernias and for enlarging the penis. The boom ended after around 20 years, as the disastrous long-term effects of these injections were gradually becoming known. Around 1950 these materials for injection were finally abandoned and replaced by collagen , for example .

further reading

Technical article

  • K. Pónyai, M. Marschalkó, J. Hársing, E. Ostorházy, Z. Kelemen, P. Nyirády, V. Várkonyi, S. Kárpáti: Paraffinoma. In: J Dtsch Dermatol Ges 8, 2010, pp. 686-688 PMID 20337771 .
  • K. Hohaus et al: Mineral oil granuloma of the penis. In: J Eur Acad Dermatol Venereol 17, 2003, pp. 585-587 PMID 12941103 .
  • RC Stewart et al: Granulomas of the penis from self-injections with oils. In: Plast Reconstr Surg 64, 1979, pp. 108-111 PMID 377327 .

Reference books

  • W. Remmle: Pathology: head and neck region, soft tissue tumors, skin. Volume 7, 3rd edition, Verlag Springer, 2008, ISBN 3-540-72884-8 , pp. 705-706. limited preview in Google Book search

Individual evidence

  1. ↑ H. Kerl: Histopathology of the skin. limited preview in Google Book search
  2. ↑ J. Steffens et al: Paraffinoma of the external genitalia after autoinjection of vaseline. In: Eur Urol 38, 2000, pp. 778-781. PMID 11111201
  3. ↑ O. Braun-Falco and HH Wolff: Dermatology and Venerology. Verlag Springer, 2005, p. 1040. ISBN 3-540-40525-9 restricted preview in the Google book search
  4. ↑ a b c T. Lee: Paraffinoma of the penis. In: Yonsei Med J 35, 1994, pp. 344-348. PMID 7975744
  5. ↑ The Late Revenge of Vaseline. ( Memento of April 17, 2012 in the Internet Archive ) (PDF; 66 kB) In: Medical Tribune 36, 2001, p. 40.
  6. ↑ P. Santos et al.: Penile paraffinoma. In: J Eur Acad Dermatol Venereol. 17, 2003, pp. 583-584. PMID 12941102
  7. ↑ a b E. Accus et al: Paraffinoma and ulcer of the external genitalia after self-injection of vaseline. In: J Sex Med 3, 2006, pp. 170-172. PMID 16409233
  8. ^ A b D. G. Moon et al .: Sexual function and psychological characteristics of penile paraffinoma. In: Asian J Androl 5, 2003, pp. 191-194. PMID 12937800
  9. ↑ a b G. Pehlivanov et al: Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma). In: J Eur Acad Dermatol Venereol 22, 2008, pp. 845-851. PMID 18355202
  10. ↑ JA Eandi et al .: Penile paraffinoma: the delayed presentation. In: Int Urol Nephrol 39, 2007, pp. 553-555. PMID 17308876
  11. ^ R. Büttner and C. Thomas: Allgemeine Pathologie. Schattauer Verlag, 2003, ISBN 3-7945-2229-X limited preview in the Google book search
  12. ↑ M. Gfesser and WI Worret: "Paraffinom des Penis" In: Der Hautarzt 1996, pp. 705–707. doi : 10.1007 / s001050050493 PMID 8999027
  13. ↑ JL Cohen et al: Penile paraffinoma: self-injection with mineral oil. In: Am Acad Dermatol 45, 2001, pp. S222-224. PMID 11712066
  14. ^ A b E. Rosenberg et al.: Three cases of penile paraffinoma: A conservative approach. In: Urology 70, 2007, 372.e9-10. PMID 17826519
  15. ↑ JH Jeong et al.: A new repair technique for penile paraffinoma: bilateral scrotal flaps. In: Ann Plast Surg 37, 1996, pp. 386-393. PMID 8905046
  16. ↑ N. Lavrentschuk et al .: Sclerosing lipogranuloma of the genitalia treated with corticosteroids. In: Int Urol Nephrol 38, 2006, pp. 97-99. PMID 16502060
  17. ↑ CK Ko et al: Scalp Paraffinoma underlying squamous cell carcinoma. In: Arch Pathol Lab Med 128, 2004, pp. 1171-1172. PMID 15387701
  18. ↑ I. Kokkonouzis et al .: Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report. (PDF; 550 kB) In: Cases Journal 1, 2008, 223. PMID 18840268 ( Open Access , under CC-by-2.0 license)
  19. ^ R. Gersuny: Hard and soft paraffin prostheses. In: Zentralbl Chir 30, 1903, p. 1.
  20. ↑ ER Engelmann et al.: Lipogranulomatosis of external genitalia. In: Urology 3, 1974, p. 358. PMID 4594721
  21. ↑ YC Oertel and FB Johnson: Sclerosing lipogranuloma of male genitalia. In: Arch Pathol Lab Med 101, 1977, p. 321. PMID
  22. ^ J. Glicenstein: The first "fillers", vaseline and paraffin. From miracle to disaster. In: Ann Chir Plast Esthet 52, 2007, pp. 157-161. PMID 16860452 (in French)
  23. ↑ H. Feldmann: The history of injections. In: Laryngorhinootologie 79, 2000, pp. 239-246. PMID 10838689