Accessory scrotum in neonate: A rare congenital scrotal anomaly

Abstract

Accessory scrotum (AS) is an extremely rare congenital anomaly, defined as scrotal-like tissue outside a normal anatomical location, without associated testes. It is often associated with perineal lipomas and other anomalies. We report a newborn male with a scrotum-like perineal mass posterior to the original scrotum. Postnatal assessment revealed a perineal mass resembling an AS. Ultrasound and CT confirmed a fat-containing mass, ruling out teratoma. A cystoscopy confirmed urinary tract integrity, and complete surgical excision of AS was conducted successfully. Although benign, AS presents a diagnostic challenge and may mimic other perineal anomalies. Complete resection is curative.

Highlights

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Accessory scrotum is an extremely rare congenital anomaly.
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There is a need for awareness of accessory scrotum as a differential diagnosis for perineal masses in neonates.
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It is an important to confirm a normal anatomy of urogenital tract.

1 Introduction

Accessory scrotum is an exceptionally rare congenital anomaly with limited number of reported cases in the literature. It typically manifests as ectopic scrotal tissue located outside its normal anatomic site, sometimes in association with perineal lipomas and anorectal malformations. The exact embryological basis remains unclear, though theories suggest defective labioscrotal fold migration or incomplete regression of fetal remnants. We present a case of a neonate with a perineal lipomatous mass resembling a scrotum ( Fig. 1 ), successfully managed with surgical excision. This case highlights the diagnostic approach, imaging characteristics, and surgical considerations for this anomaly.

2 Case presentation

A full-term male neonate, born via vaginal delivery with no significant antenatal findings, presented with a soft, non-tender, scrotum-like perineal mass posterior to the original scrotum. The penis, testes, and primary scrotum appeared normal. No associated anorectal or urogenital malformations were observed. Imaging studies were performed to evaluate the nature of the mass: Ultrasound demonstrated a well-defined, hyperechoic mass suggestive of adipose tissue with no solid or cystic components, CT Scan confirmed a homogeneous fat-containing lesion with no calcifications, ruling out teratoma, and cystoscopy confirmed normal urinary tract anatomy.

3 Surgical management

The incision was made starting from the anterior side of the mass ( Fig. 2 ), and complete excision of the accessory scrotum and perineal lipoma was performed while preserving the surrounding structures ( Fig. 3 ). Histopathological examination confirmed the presence of mature adipose tissue with no evidence of malignancy. The patient recovered without any complications, and there was no recurrence at follow-up ( Fig. 4 ).