An unusual pediatric scrotal lump
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Extratesticular tumors in the pediatric population comprise most commonly of lipomas (most often arising from the spermatic cord) and adenomatoid tumors (most often found in the epididymis). Despite their relative rarity, malignant neoplasms do occur and include rhabdomyosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma, and lymphoma.[1]
Here is a case report of a scrotal wall angiolipoma. A two-and-half year old child was brought to the pediatric surgical outpatient clinic by his grandmother, with a painless lump in the scrotal wall. The duration of the swelling was unclear, but probably of few months only from the vague history. There was no history of trauma, sudden change in the swelling's dimensions or the overall growth and development of the child.
Clinical examination confirmed that the swelling was a solid one, just under the skin, firm in consistency, pinchable from the rest of the scrotum and non-tender. The appearances seemed to be concurrent with that of a lipoma. The testes and epididymis on either side were normal as shown in Figure1.
Ideally, an ultrasonogram would have been the initial investigation of choice[2], but due to the nonavailabilty on that day, excision biopsy[3] was planned for the following day; this swelling was easily excised in toto and sent for histology. Intra-operatively, the initial clinical findings were confirmed and no communication with intra-scrotal contents ensued.
The histology was reported as a well encapsulated benign lesion consistent with an angiolipoma. Post-operative period was uneventful.
Extratesticular scrotal contents consist of the epididymis, spermatic cord, and fascia derived from the embryologic descent of the testis through the abdominal wall. As opposed to intratesticular masses, most extratesticular masses are benign. Cystic masses (including hydroceles, epididymal cysts, and varicoceles) are easily diagnosed with ultrasonography (US) and are benign. The US findings of solid masses are often non-specific but easily available and useful preliminary tests. Magnetic resonance imaging can be very helpful in the evaluation of some of these disorders, allowing for a more specific diagnosis in cases of lipoma, fibrous pseudotumour. Scrotal sonography is an excellent non-invasive method to discern the location of scrotal masses. The most common extratesticular neoplasms are lipomas (most often arising from the spermatic cord) and adenomatoid tumours (most often found in the epididymis). Lipoma arises from fat cells within the internal spermatic fascia and presents like an inguinal hernia. Other soft tissue lesions, including fibromas, leiomyomas, lymphangiomas, adrenal rest tumours, and dermoid cysts, are exceedingly rare. Absolute certainty of benign or malignant nature is only by a biopsy despite strong clinical features towards any one entity. In patients who are not, reliable for regular follow up as in many Indian rural patients, diagnostic certainty is quintessential.
References
1. Woodward PJ, Schwab CM, Sesterhenn IA. Extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics 2003 Jan-Feb; 23(1): 215-240.
2. Frush DP, Sheldon CA. Diagnostic imaging for pediatric scrotal disorders. Radiographics 1998 Jul-Aug; 18(4): 969-985.
3. Skoog SJ. Benign and malignant pediatric scrotal masses. Pediatr Clin North Am 1997 Oct; 44(5): 1229-1250.(Rajagopalan Sriram)
Extratesticular tumors in the pediatric population comprise most commonly of lipomas (most often arising from the spermatic cord) and adenomatoid tumors (most often found in the epididymis). Despite their relative rarity, malignant neoplasms do occur and include rhabdomyosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma, and lymphoma.[1]
Here is a case report of a scrotal wall angiolipoma. A two-and-half year old child was brought to the pediatric surgical outpatient clinic by his grandmother, with a painless lump in the scrotal wall. The duration of the swelling was unclear, but probably of few months only from the vague history. There was no history of trauma, sudden change in the swelling's dimensions or the overall growth and development of the child.
Clinical examination confirmed that the swelling was a solid one, just under the skin, firm in consistency, pinchable from the rest of the scrotum and non-tender. The appearances seemed to be concurrent with that of a lipoma. The testes and epididymis on either side were normal as shown in Figure1.
Ideally, an ultrasonogram would have been the initial investigation of choice[2], but due to the nonavailabilty on that day, excision biopsy[3] was planned for the following day; this swelling was easily excised in toto and sent for histology. Intra-operatively, the initial clinical findings were confirmed and no communication with intra-scrotal contents ensued.
The histology was reported as a well encapsulated benign lesion consistent with an angiolipoma. Post-operative period was uneventful.
Extratesticular scrotal contents consist of the epididymis, spermatic cord, and fascia derived from the embryologic descent of the testis through the abdominal wall. As opposed to intratesticular masses, most extratesticular masses are benign. Cystic masses (including hydroceles, epididymal cysts, and varicoceles) are easily diagnosed with ultrasonography (US) and are benign. The US findings of solid masses are often non-specific but easily available and useful preliminary tests. Magnetic resonance imaging can be very helpful in the evaluation of some of these disorders, allowing for a more specific diagnosis in cases of lipoma, fibrous pseudotumour. Scrotal sonography is an excellent non-invasive method to discern the location of scrotal masses. The most common extratesticular neoplasms are lipomas (most often arising from the spermatic cord) and adenomatoid tumours (most often found in the epididymis). Lipoma arises from fat cells within the internal spermatic fascia and presents like an inguinal hernia. Other soft tissue lesions, including fibromas, leiomyomas, lymphangiomas, adrenal rest tumours, and dermoid cysts, are exceedingly rare. Absolute certainty of benign or malignant nature is only by a biopsy despite strong clinical features towards any one entity. In patients who are not, reliable for regular follow up as in many Indian rural patients, diagnostic certainty is quintessential.
References
1. Woodward PJ, Schwab CM, Sesterhenn IA. Extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics 2003 Jan-Feb; 23(1): 215-240.
2. Frush DP, Sheldon CA. Diagnostic imaging for pediatric scrotal disorders. Radiographics 1998 Jul-Aug; 18(4): 969-985.
3. Skoog SJ. Benign and malignant pediatric scrotal masses. Pediatr Clin North Am 1997 Oct; 44(5): 1229-1250.(Rajagopalan Sriram)