IS Case 310: Scrotal lipoma

Malin Cesarz, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-14

History

Patient is a 77-year-old male who presented with the complaint of right scrotal swelling for 9 months.

Findings

Both axial CT image (Fig. 1) and coronal MPR CT image (Fig. 2) through the scrotum demonstrate a large fatty mass with a soft tissue core and septations. There is scrotal skin thickening.

Diagnosis

Scrotal lipoma

Discussion

Primary lipomas of the scrotum are rare. Most accounts in the scientific literature are case reports. The main concern when a fatty mass is identified within the scrotum or elsewhere is whether the mass could be a liposarcoma.

Some distinguishing features include:

* Lipoma: Homogeneous and well defined, with attenuation between -50 HU and -150 HU.

* Liposarcoma: Heterogeneous with attenuation greater than -50 HU. Inhomogeneous fat suppression on MRI.

These characteristics are not pathognomonic however. Fine septations can be seen in lipomas on CT and MRI. Even at pathology, the differentiation can be difficult.

Due to the large size and heterogeneous appearance of the mass in this case, it was surgically excised.

References

  1. Adam A, Dixon AK, Eds. Grainger & Allison's Diagnostic Radiology, 5th ed., Elsevier Churchill Livingstone, 2008. [MDConsult]
  2. Szmigielski W, Khairat M, Haider A, Ejeckam GC. Huge scrotal lipoma masquerading as haematoma. Clin Radiol. 2000 Jun;55(6):479-80. PMID: 10873696
  3. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, Eds. Campbell-Walsh Urology. 9th ed., Saunders Elsevier, 2007. [MDConsult]

2 images