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The patient underwent an uneventful left inguinal radical orchiectomy with high ligation of the spermatic cord in the usual manner. No inguinal hernia was noted on the CT scan. A subsequent computed tomography (CT) scan to further characterize the left inguinal hernia showed a 6.7 × 6.1 × 5.8-cm mass suggestive of possible scrotal lipomatosis or spermatic cord lipoma on the left, containing a 2.5-cm ill-defined area of soft tissue attenuation and possible low-grade liposarcoma ( Figure 1).
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His initial work-up included a scrotal ultrasound, which was significant for fat containing left inguinal hernia with extension into the scrotal sac and a small left varicocele. On initial examination, no discrete testicular mass was described. Patient initially presented in the community with left groin bulge in the setting of prior inguinal hernia repair. We present a 65-year-old male with a past medical history significant for benign prostatic hyperplasia status-postgreen light laser ablation, Peyronie’s disease, and bilateral inguinal hernia repair that initially presented for evaluation of recurrent inguinal hernia and found to have a scrotal cord mass on cross-sectional imaging. Here, we present a case of spermatic cord spindle cell lipoma to add to the current literature and discuss the current diagnostic paradigm. The incidence of spindle cell lipoma in any location is rare, accounting for only 1.5% of all lipomas and even more rare as presentation in the spermatic cord with a literature search demonstrating only a handful of case reports ( 1). Spindle cell lipoma (SCL) is a soft tissue neoplasm first described in 1975 that is typically found on the back, shoulders, and neck of adult males around 40–70 years of age ( 1). Histological investigation later concluded that this represented a benign, spindle cell lipoma of the spermatic cord as evidence by positive CD34 staining and microscopic analysis.Ĭonclusion: Although this particular variant of lipoma is rare, it is the hope that these findings contribute to the continued study of this disease process and can potentially prompt further evaluation prior to radical orchiectomy to limit patient morbidity. Only three other cases have been reported in medical literature.Ĭase Presentation: We present the fourth case of spindle cell lipoma of the spermatic cord, which in this particular case had imaging findings suggestive of a malignant liposarcoma prompting radical orchiectomy. Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, FL, United Statesīackground: Spindle cell lipomas are uncommon variants of typical lipomas, and presentation within the spermatic cord is exceedingly rare.Aaron Dahmen, Timothy Juwono, Nicholas W.