Scrotal elephantiasis associated with follicular occlusion t
A 41-year-old man came to us because of a large scrotal cyst and generalized skin lesions that had occurred over the past 10 years. The generalized skin lesions consisted of HS on the perineum and back, AC in the armpit, and dissecting cellulitis of the scalp. His left scrotal cyst reached a profound size of 20 cm × 13 cm × 9 cm. He initially presented generalized skin lesions and then scrotal cyst developed 1 year later. Magnetic resonance showed a mass in the left scrotum with clear boundaries. The right testis measured 3.1 cm × 3.1 cm × 1.9 cm, and the left testis measured 3.1 cm × 2.8 cm × 1.9 cm. The morphology and envelope of the bilateral testes were normal. He took antibiotics orally and intermittently to prevent infection, but this approach achieved a poor effect. In addition, he had a history of type 2 diabetes and denied any history of promiscuity. A routine blood test showed a high leukocyte level of 12 × 109/L and a hemoglobin content of 78 g/L. C-reactive-protein increased. We also performed a series of autoimmune antibody tests, and all the results were negative. He refused any genetic test.

Based on the clinical and laboratory findings, a diagnosis of a variant of FOT was made. We removed skin abscesses and washed the inner part with hydrogen peroxide and saline. We covered the wounds with vacuum suction and performed an excision of the scrotal lesion. The boundaries of the large cyst were in close proximity with the tunica vaginalis of the left scrotum. We separated the large cyst entity from the tunica vaginalis carefully, without any damage to the testis. The postoperative pathologic findings showed that the mass was an epidermoid cyst, and hematoxylin and eosin (H&E) staining showed hyperkeratosis of the skin as well as inflammatory and edematous changes. Until now (16 months later), there has been no evidence of any recurrence, and the patient is recovering well. The patient has provided informed consent for publication of the case.

Source: Medicine: April 2019 - Volume 98 - Issue 16 - p e15263

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