Case of the Week: May 31-June 7, 2012

13 year old male rule out hydrocele

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Case Details

Ultrasound shows an extratesticular mass that is echogencic. CT shows the mass to be homogeneous and fat-containing.

Answer

Diagnosis: Lipoma of Scrotum

     Lipoma is the most common extratesticular neoplasm and originates from the fat cells of the spermatic cord or subcutaneous fat in the scrotal wall.

The vary in size, but are usually fairly homogeneous, well-defined and range in H.U. of -50 to -150.   

   Unfortunately imaging is not pathognomonic.

 Liposarcoma can appear similarly, but usually is more inhomogeneous with areas of higher attenuation.Lipomas can undergo sarcomatous degeneration as well.     

 Other extratesticular tumors include adenomatoid tumor(benign, originating in the epididymus or spermatic cord), spermatic cord sarcoma, rhabdomyosarcoma, metastases, fibrous pseudotumor( reactive after inflammation), polyorchidism, hematoma, sclerosing lipogranuloma and sarcoidosis.

All of these lesions are soft tissue attenuation or density(MR) rather than fat.

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