Perineal lipoma in association with scrotal anomalies in children

Accessory Scrotum - Truly an Appendage?

Accessory scrotum is defined as extra scrotal tissue in the vicinity of the anatomically located normal scrotum. We report a case of 4-day full-term male neonate with a unilateral accessory scrotum. We have discussed clinical presentations and associated anomalies of an accessory scrotum thus guiding its evaluation and treatment.

Unilateral Suprainguinal Ectopic Scrotum: Case Report and Literature Review

Ectopic scrotum is an infrequent congenital scrotal anomaly. Different surgical methods of correcting ectopic scrotum have been used, but none have produced optimal cosmetic results for all types. We describe a case of left ectopic suprainguinal scrotum in a 14-month-old boy who had an undescended left testicle and a left-sided scrotal skin tag. Single-stage rotational flap scrotoplasty and unilateral orchiopexy were performed; however, we modified the surgical technique of scrotal rotation by excising the intervening longitudinal skin. Eight months after surgery, the repositioned scrotum had a better appearance, and the affected testicle was similar in size to the contralateral one. In comparison with other surgical methods, pedicle flap rotation of the ectopic scrotal skin with excision of the intervening longitudinal skin may produce a better cosmetic outcome.

Case Report: Congenital Perineal Lipoma Associated With Additional External Genitalia Anomalies

Perineal lipoma is an uncommon congenital benign tumor sometimes associated with genitourinary or anorectal malformations. Accessory scrotum and accessory labioscrotal fold are infrequent features, often concurrent with perineal tumors. We describe a single institution experience with three consecutive cases of perineal lipoma associated with external genital anomalies, and a literature review.

Accessory Scrotum

Introduction: An accessory scrotum is characterized by a characteristic skin appearance in addition to a normal scrotum in the anatomically normal position. Case report: We report an accessory inguinal left hemiscrotum in a 15-day-old male infant. There was a normal scrotum and penis. The testes were descended and normally located within the normal scrotum. Additional scrotal skin was located anterior and lateral to the normal scrotum. Conclusion: The accessory ectopic scrotum is readily observed by physical examination. Cosmetic excision is the treatment of choice.

Congenital perianal lipoma: a case report and review of the literature

Background

The surgical strategy for congenital perineal lipoma varies depending on the size, location, and accompanying congenital anomalies, with the optimum approach remaining to be determined. We herein report a case of congenital perianal lipoma that was first detected by prenatal ultrasound and review the literature.

Case presentation

A female neonate was referred to us for the evaluation of a perianal mass. She had been considered to be male prenatally because fetal ultrasound showed a perineal mass similar to a scrotum and penis. A postnatal examination revealed an appropriate-for-age neonate with a soft round mass 1.5 cm in diameter just to the left of the anal verge. She passed urine and stool smoothly, and contrast enema confirmed no anorectal malformation. Magnetic resonance imaging showed that the lesion had a signal intensity consistent with fat located close to the anal sphincter, and no spinal anomaly (e.g., spina bifida) was identified. We excised the lesion (pathologically confirmed to be lipoma) simply at 2 months old, taking care to avoid damaging the anal sphincter by using a muscle stimulator. She has been doing well with good bowel movement and satisfactory cosmetic results for a follow-up period of one and a half years.

Our literature search revealed 49 cases of perineal lipoma reported in English in the last 25 years, and 74% of them—including ours—had other congenital anomalies, the breakdown of which was anorectal malformation in 40% of cases, labioscrotal fold or accessory scrotum in 28%, and urogenital malformation, congenital pulmonary airway malformation, and disorder of sex differentiation. The prenatal detection of the lesion, as in our case, was quite rare.

Conclusion

A thorough physical examination after birth, magnetic resonance imaging and contrast enema to identify the nature of the perineal lipoma and accompanying anomalies are crucial for planning the surgical strategy. The lesion may be deeply interspersed between the sphincter muscle, especially when it accompanies anorectal anomaly. A muscle stimulator is useful for preserving and repairing the sphincter muscles during resection in order to ensure satisfactory bowel movement.

The Utility of Magnetic Resonance Imaging in the Evaluation of Accessory Scrotum in the Newborn

Accessory scrotum, a rare form of congenital scrotal anomaly that is often associated with other genitourinary and anorectal anomalies, is characterized by ectopic scrotal tissue in the presence of a normal, orthotopic scrotum. Here, we present a case of accessory scrotum in a newborn male. We describe our experience with the utilization of preoperative pelvic magnetic resonance imaging to characterize the complex relationship between the accessory scrotum and ano-sphincteric complex, as well as identify associated genitourinary abnormalities. We also provide a brief literature review.

Pseudoduplication of the external genitalia

A 1-year-old boy was referred to our department with a pseudoduplication of the external genitalia present since birth. At surgery, we performed a complete excision of the mass through a "Y-type" perineal incision. The boy was taken to our department for a regular physical examination 2 years after the surgery. The appearance of the perineal region was satisfactory.

Accessory scrotum attached to a peduncular perineal lipoma

In this study, we report on the case of a newborn boy diagnosed after birth with an accessory scrotum attached to a peduncular type of perineal lipoma without any other associated congenital anomalies. The neonate underwent a simple surgical excision of the lipoma and accessory scrotum in the first month of life, and his postoperative course was uneventful. Histologic examination revealed normal scrotal skin and adipose tissue. Accessory scrotum has a high incidence of association with perineal lipoma (83% of reported cases) and other urogenital and anorectal anomalies, but urogenital or anorectal anomalies were not seen in our patient.

Perineal lipoma associated with penoscrotal transposition in a neonate

A neonate with perineal lipoma associated with penoscrotal transposition and bifid scrotum is reported.

Congenital vulvar lipoma within an accessory labioscrotal fold

Perineal lipomas are uncommon congenital anomalies. They mainly develop in male patients with an accessory scrotum, posterior to the original scrotum. However, on rare occasions, these lipomas can occur in female patients with an accessory labioscrotal fold. We report on three such cases, where the lipomas were found in the anterior part of the right side of the labia majora. None had other anomalies, with the exception of one who had premature growth of pubic hair on the accessory labioscrotal fold. Skin with a rugated scrotal appearance was present in all cases.