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.