DISCUSSION
Lipoma are benign mesenchymal neoplasms with rare occurrence in the
scrotum [1]. Primary scrotal lipoma usually originates from
spermatic cord. However, it can also originate outside the spermatic
cord or in subcutaneous tissue [1-3]. We present an extremely rare
case of primary scrotal lipoma which originated from subcutaneous
tissue.
Primary scrotal lipoma can occur in any age group. Most of the time it
is unilateral with variable size [6-8 ]. Clinical presentation is
not specific but most patients present with scrotal mass which may be
diagnosed incidentally on clinical examination or the patient himself
may complain of scrotal mass when it is significantly increased [6].
Like in our case, most of the time clinicians think of varicocele,
hydrocele, testicular tumor, inguinal scrotal hernia or epididymorchitis
[7] whenever they encounter a testicular mass. Ultrasound and
computed tomography are helpful in diagnosing scrotal lipoma but require
an experienced ultra-sonographer. Typical finding in ultrasound is
hypo-echoic mass, no blood flow and the boundaries may be clear or not
clear [7]. There is no pathognomonic finding from history,
examination neither imaging which poses a diagnostic challenge to
clinicians. In our case, impression from ultrasound was hydrocele and
testicular tumor at peripheral hospital and KCMC hospital respectively.
Furthermore, in our case the first ultrasound suggested the mass to be
hydrocele and the differential diagnosis of scrotal lipoma was missed.
Definitive treatment for scrotal lipoma is lipectomy to remove pressure
symptoms and also to prevent its progression to liposarcoma although
it’s a rare occasion . In our case, lipectomy was done and patient was
free of symptoms. Primary scrotal lipoma has a good prognosis [8].