CASE PRESENTATION
A 40 year male presented with one year history of scrotal swelling which
was progressively increasing in size and associated with on and off
pain. The patient reported no other symptoms in reminiscence. He had no
known history of chronic illness neither family history of the same
clinical presentation. He attended a primary center where he was
diagnosed to have hydrocele and underwent scrotal surgery. He has no
history of undescended testis, prior scrotal surgery neither family
history of testicular cancer. Intraoperative, the surgeon couldn’t find
a fluid filled sac instead a huge solid mass was identified. They
couldn’t figure out the possible diagnosis and therefore the procedure
was abandoned by closure of the incision. The patient was then referred
to urology department of a tertiary hospital for further evaluation and
possible treatment.
On arrival he was conscious and no lympnodes were palpable in general
examination. Abdominal examination was unremarkable. The external
genitalia revealed medial raphe scrotal incision and mild tender, firm,
irreducible, left hemiscrotum mass measuring about 7x 10 cm. The
ipsilateral testis could not be felt separate from the mass and could go
above the mass easily. A diagnosis of testicular cancer with
differential of epididymochitis and infected hydrocele were entertained.
Laboratory investigations were within normal limits including α- fetal
protein, β- HCG and lactate dehydrogenase. Scrotal ultrasound reported
features suggestive of malignant scrotal mass while abdominal ultrasound
revealed normal findings.
Testicular exploration was planned through inguinal crease incision in
urology theatre following his consent .At exploration, the incision was
extended to the scrotum, the spermatic cord was clumped high up at the
inguinal area and followed down to the scrotum. The whole spermatic cord
and testis were normal but there was well circumscribed fatty like mass
in the scrotum on the lateral aspect of the testis. The mass was firmly
attached to the scrotal wall. The impression of scrotal lipoma was made
(figure1) and excision was done and incision was closed in
layers(figure2). The tissues were taken to pathology department for
histopathology assessment that confirmed to be a lipoma(Figure 3 and 4).
Post-operative period was uneventful and the patient was discharged on
day 4 post operatively and sutured removed on day 10 postoperative. The
patient has been attending the clinic regularly and currently a year
after excision where was found to have no any recurrence.