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Surgery Strawberry scrotum

Iqbal Singh, Nain Singh, Naveen Sharma, Sarla Agarwal,1 R. Tandon1


Departments of Surgery and 1Pathology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi, India.

For correspondence:
Dr. Iqbal Singh, Department of Surgery, UCMS & GTBH, F-14 NDSE-2, New Delhi 110040, India. E-mail: iqbalsinghp@yahoo.co.uk

Key words: Calcified epidermal cysts, calcinosis cutis, scrotal calcinosis

How to cite this article:


Singh I, Singh N, Sharma N, Agarwal S, Tandon R. Strawberry scrotum (Idiopathic nodular scrotal calcinosis): Image in surgery. Indian
J Surg 2005;67:159.
in

A 35-year-old man presented with painful areas of dystrophic calcification, epitheloid cells, for-
scrotal swellings for the last 8 years and local eign body giant cells, sclerosis, and partial coalescence
itching with occasional discharge of whitish of calcified nodules without any inflammatory reac-
Images

chalky material. Local examination revealed tion. Scrotal calcinosis (SC) or calcinosis cutis is the
multiple diffuse nodular swellings [Figure 1] presence of calcified masses within the scrotal skin or
about 6 x 8 cm, arising from the anterior scro- dermis. Though commonly idiopathic[1] recent reports
tal skin covered with multiple white, hard, suggest that the basic underlying abnormality may be
stippled chalk-like excrescences (strawberry). inflammation and or infection of the scrotal epider-
The external genitalia and groin did not show mal inclusion cysts,[2] necrosis may serve as a nidus
any abnormality. Under local anesthesia, he for dystrophic calcification of these cysts. The pres-
underwent en-bloc excision of the anterior ence of a high content of calcium and phosphorus crys-
scrotal skin and primary skin closure. Histopa- tals in these calcified nodule suggests a degenerative
thology revealed scrotal dermal calcinosis with origin and calciphylaxis (deposition of calcium in the
small blood vessels with ischemic necrosis and infec-
tion of the overlying skin) of the scrotal skin.[3]

Due to the absence of subcutaneous fat in the scrotal


skin, these calcifications were easily seen through the
thin parchment-like thermosensitive scrotal skin. Su-
peradded scrotal itching and infection may have con-
tributed to cuticular necrosis causing the chalky de-
posits to be leached out and giving rise to its atypical
strawberry-like appearance and this may have con-
tributed to the histological evidence of occasional are-
as of foreign body giant cell reaction in the absence of
any inflammation, as seen in this case.

REFERENCES
1. Wright S, Navsaria H, Leigh IM. Idiopathic scrotal calcinosis
is idiopathic. J Am Acad Dermatol 1991;24:727-30.
2. Saad AG, Zaatari GS. Scrotal calcinosis: is it idiopathic?
Figure 1: Photograph of the strawberry-like scrotum Urology 2001;57:365-3. So A, Bell D, Metcalfe P, Gupta R.
showing the typical white stippled calcified scrotal Calciphylaxis of the penis: a unique cause of Fourniers
nodules gangrene. Can J Urol 2001;8:1377-9.

Paper Received: August 2004. Paper Accepted: September


2004. Source of Support: Nil.

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