Hibernoma of the spermatic cord. The second reported case and literature review

A large thigh hibernoma in a 23-years-old man: Case report

INTRODUCTION AND IMPORTANCE

Hibernomas are benign soft tissue tumors containing prominent brown adipocytes that resemble normal brown fat, they occur in a wide age range (from 2 to 75 years) and make up for about 1 % of all adipocytic tumors <2 % of benign fatty neoplasms. They have traditionally been regarded as benign tumors with no potential for malignancy; due to their similarity in clinical and radiographical presentation, they are often misdiagnosed as malignant tumors like liposarcomas. While these tumors are generally considered non-malignant, their distinctive characteristics and uncommon occurrence make them an intriguing subject for medical study.

CASE PRESENTATION

This article describes the clinical, radiographic, and histologic features of a young patient with a thigh hibernoma compressing the obturator nerve.

CLINICAL DISCUSSION

Hibernomas are more likely to develop in brown fat-enriched areas in newborns, such as the neck, scapular area, armpit, chest, and retroperitoneum. Increased awareness among clinicians and pathologists, coupled with advances in imaging and immunohistochemistry, has enhanced our ability to accurately identify and treat these intriguing tumors.

CONCLUSION

The rarity of hibernomas together with the close resemblance of their radiological features to those of malignant tumors like liposarcomas or atypical lipomatous tumors, make these lesions extremely difficult to identify and often misdiagnosed. Continued research is essential to further our understanding this neoplasm and refine diagnostic and therapeutic approaches.

Differential diagnosis of fat-containing lesions in the inguinal canal using ultrasound

Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.

Hibernoma: a case report demonstrating usefulness of MR angiography in characterizing the tumor

Hibernoma is a rare, benign soft-tissue tumor composed of brown fat. In the past, there has been an extensive discussion of the CT attenuation and MRI signal characteristics of hibernomas. However, recent reports have focused upon the tumor vascularity of hibernomas. We describe the only case in the literature which utilizes state of the art contrast enhanced MR angiography to clearly characterize the surface and intratumoral vessels to help confirm the diagnosis of a hibernoma and aid in the preoperative planning.