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].