A rare case of intrascrotal lipoblastoma in a 2-year-old: Case report and literature review

Abstract

Lipoblastomas are rare benign tumors arising from embryonal fat tissues, commonly occurring in early childhood. Scrotal presentation is exceedingly rare, with 18 cases reported in the literature. We present a 2-year-old male with a 5-month history of painless scrotal swelling, initially suspected of being malignant. Imaging suggested the possibility of atypical lipoma. The patient underwent orchiectomy. Histopathologic examination confirmed the diagnosis of lipoblastoma, with no MDM2 amplification. After two years of follow-up, the patient remains recurrence-free. This case highlights the challenges of diagnosing pediatric scrotal masses preoperatively and highlights the importance of a multidisciplinary approach for accurate diagnosis and management.

1 Introduction

Lipoblastomas are rare tumors arising from embryonic white fat. They primarily occur in infancy and early childhood, 88 % presented before age of 3, most commonly presents in soft tissues in the upper and lower extremities, here we report a rare case of a 2-year-old who presented with painless scrotal swelling our top differential based on physical and radiological assessment was malignancy, orchidectomy was done and found to be a lipoblastoma on the pathology report.

2 Case presentation

A 2-year-old previously healthy male presented with a 5-month history of painless scrotal swelling. There were no associated urinary symptoms, skin changes, altered bowel habits, or nausea. A comprehensive genitourinary review was negative for hematuria and dysuria.

On physical examination, the right testicle was unremarkable, with normal size and shape. However, the left testicle exhibited a soft, non-tender, multicystic supratesticular swelling with no signs of infection.

Imaging studies were performed to further evaluate condition. A scrotal ultrasound ( Fig. 1 ) revealed an enlarged left testis with a volume of 20 mL and a questionable echogenic structure inferior to the left testicle. Subsequently, an MRI was performed for further assessment of the mass ( Fig. 2 ) which demonstrated a large lobulated extratesticular mass with septations measuring approximately 4.5 × 2.6 × 2.6 cm. The mass appear to displace the left testicle inferiorly and suggests a possible involvement of the epididymis. The mass extended cranially, anterior to the spermatic cord, and reached the level of the left inguinal canal. The lesion was inseparable from the anterior aspect of the spermatic cord, indicating the likelihood of a fat-containing tumor.