This 44 year old initially presented with diffuse adenopathy in many lymph node groups, including inguinal nodes as pictured. This proved to be a follicular lymphoma and he received oral cyclophosphamide with a partial response, with treatment interrupted by (re)imprisonment.

On followup 6 months later, he had progressive adenopathy, apparently including the dorsum of the penis. I intially interpreted these discrete nontender masses as lymph nodes, noting that the penis was a very unusual site for adenopathy. The patient corrected me and stated that the penile masses were not nodes but “pearls” which he had placed there. The patient, of Hispanic origin, told me that this was an Oriental practice intended to increase pleasure for his female sexual partners [1].

The clinical pearl in this case is the fact that there are not lymph nodes in the penis, which drains to inguinal nodes. Even in the context of widespread adenopathy, discrete penile masses represent something other than lymph nodes Figure 1.

Figure 1: Adenopathy of the Penis.

1. Stankov O, Ivanovski O, Popov Z (2009) Artificial penile bodies-from kama sutra to modern times. J Sex Med 6:1543-1548.