INTRODUCTIONPyogenic granuloma is an acquired non-cancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma appears as a painless papule or lump that may bleed with or without minor trauma.(1)(2). Usually takes the form of a polypoid and can be further classified into subtypes including eruptive, dermal, intravascular, and subcutaneous. Head skin, oral mucosa, gingiva, trunk, neck, lower and upper extremities and perianal are the most common places, with the genital areas being the least common.(3). Vascular malformation, oral contraceptives, hormonal factors, pregnancy, and skin irritations resulting from trauma, poor hygiene, vasculitis, foreign objects, inflammatory skin conditions, oral retinoid therapy, and antiretroviral medication indinavir are among the factors that predispose an individual to this condition. Recent researches indicates that 7% of instances include mild trauma.(4)(5)(6)(7)(8). It is astounding that micro damage during sexual activity is prevalent while genital pyogenic granuloma is uncommon. (9)(10). We present a case of 24years old male who presented at our facility with distal penile ulcerated polypoidal nodules.

INTRODUCTIONPyoderma gangrenosum (PG) is a rare, primary sterile, inflammatory, non-infective, and non-malignancy skin disease that is classified into four variants (ulcerative, pustular, bullous, and vegetative) (Table 1). Up to 50% of PG cases might have systemic diseases such as hematological malignancy, rheumatoid arthritis, paraproteinemia, myeloproliferative disorder, and inflamatory bowel diseases such as Crohn’s disease and ulcerative colitis. It’s found that up to 5% of cases of PG have ulcerative colitis and 1.5% have Crohn’s disease (1), (2), (3), (4), (5). In the 1930s, Brunsting et al. were the first to define PG as a disease entity. They described it in five patients who presented with large, painful necrotic ulcers with undermined borders of bluish coloration enclosed by regions of erythema. In those five patients, four had ulcerative colitis. The cause is still unknown, though it was hypothetically thought to be a bacterial disease and sometimes a cutaneous manifestation of inflammatory bowel disease, which has been refuted by current studies (2).The incidence of PG annually in the United States is estimated to be 1 case in 100,000, while the worldwide incidence is between 3 and 10 million. General PG is a diagnosis of exclusion, with penile conditions having considerable differentials, including infections such as syphilis, amoebiasis, herpes simplex, mycobacterial ulceration, and non-infectious origins of venereal ulceration like cutaneous Crohn’s disease, squamous cell carcinoma, and ulcerating sarcoidosis. It should be considered in lesions where antimicrobial or antiviral therapy has not responded or for the non-confirmatory diagnosis of skin conditions (6). Frequently, PG occurs between the ages of 25 and 54, though it might occur at any age. It is extremely rare in pediatrics; 4% of cases have been reported in pediatrics and infants; in infants alone, 8.8% of all pediatric cases are reported. The youngest reported case is 3 weeks old. Females are more affected than males, and their peak age is in their third and fourth decades, while their counterpart males are in their fifth decade. The initial lesion is a tender pustule, whereas in infants, the areas involved are perianal and genital, and in children, the lesions involve the head, face, and gluteal areas (4).Typically, PG lesions start as small vesiculopustular, which progresses to an ulcer with violaceous overhanging borders, and these occur mostly in the lower extremities, though not limited to other organs. In this typical form, it is believed that if the condition is associated with arthritis, they become more refractory to treatment than those without arthritis. Atypical forms are clinically presented as superficial lesions with blue-gray bullous borders involving the extremities, head, and neck. Regardless of the presence of other systemic conditions, it can be acute or chronic. A PG patient presents with a condition called pathergy, which is the development of a lesion at a site of trauma, whether it be iatrogenic, animal bites, or any injury, and it is due to hyper-reactivity of the skin (8). Apart from PG, other conditions that may present with pathology are sweet syndrome, blindloop syndrome, erythema elevatum diutinum, and Behcet’s disease. Pathergy should not be confused with the Koebner/isomormorphic response, which is the formation of new skin lesions in areas that were not involved in trauma. 10–30% of PG reported cases are idiopathic; 20% of patients will present with a Koebner response, while 20–30% will present with pathology (9, 10).

Vitus Kajerero1, Okoa Sukunala1, Remigius A. Rugakingira1, Alphonce Chandika2 Orgeness J. Mbwambo3, Edward Msokwa41Department of Urology, Benjamin Mkapa Hospital, P.O Box 11088 Dodoma, Tanzania.2Departiment of General Surgery, Benjamin Mkapa Hospital, P.O Box 11088 Dodoma, Tanzania3Department of Urology, Kilimanjaro Christian Medical University College.P.O.Box 2240, Moshi.Tanzania.4Departiment of Surgery, School of Medicine and Dentistry, University Of Dodoma P.O Box 259 Dodoma, Tanzania

Primary scrotal lipoma is a rare urological diagnosis. It is usually diagnosed incidentally as most of time initial diagnosis may be confused with other common etiology of scrotal masses. Here, we present a case a rare case of scrotal lipoma with initial misdiagnosis of hydrocele at primary health facility.