Perineal lipoma in association with scrotal anomalies in children

OBJECTIVE: To analyse the characteristics of the perineal lipoma and speculate on its development, as an associated perineal lipoma is implicated in the occurrence of scrotal anomalies in children. PATIENTS AND METHODS: Five children with a perineal lipoma in association with various scrotal anomalies were included in the study. We analysed the types of scrotal anomalies and their anatomical relationship with the perineal lipomas. RESULTS: One child had a supra-inguinal ectopic scrotum, and the others had penoscrotal transposition, either symmetrical or asymmetrical; they included two who had an accessory scrotum combined with a perineal lipoma. The perineal lipoma was on the ipsilateral side of the upward-positioned hemiscrotum in the ectopic scrotum or the asymmetrical penoscrotal transposition, or it was on the mid-perineum in the symmetrical penoscrotal transposition. CONCLUSIONS: The perineal lipoma can be found combined with various scrotal anomalies, including ectopic scrotum as well as an accessory scrotum or penoscrotal transposition; this is the first report describing a perineal lipoma associated with an ectopic scrotum. We speculate that the development of the perineal lipoma is closely related to scrotal anomalies, which result from early division and/or abnormal migration of the labioscrotal swelling. The concomitant perineal lipoma might be formed during the process, and might affect abnormal scrotal development.     

Accessory scrotum attached to a perineal lipoma in an adult male

Accessory scrotum is a condition in which a scrotum is located in the perineal region, in addition to the presence of normally located primary scrotum, testes and penis. The condition is extremely rare and the majority of reported cases have been diagnosed in infants. Herein, we present a case of accessory scrotum attached to a perineal lipoma in a 40-year-old man. The perineal mass was present at birth and grew very slowly over the years. There were no other congenital abnormalities or problems related to this anomaly. The case was easily managed by complete excision of the accessory scrotum and perineal lipoma. Gross and microscopic examination of the surgical specimen revealed an accessory scrotum attached to an encapsulated perineal lipoma. The present case demonstrates an adult prognosis of a patient born with this type of abnormality. To our knowledge, it is the first case of its kind to be reported in the literature.     

An accessory labioscrotal fold associated with anorectal malformation in female neonates

The association of perineal lipomas with anorectal malformations in the newborn has been reported previously (Shaul DB, Monforte HL, Pena A, et al. Surgical management of perineal masses in patients with anorectal malformations. J Pediatr Surg 2005;40:188-191; Wester T, Rintala RJ. Perineal lipomas associated with anorectal malformations. Pediatr Surg Int 2006;22:979-981). Only 2 cases of accessory labioscrotal fold with perineal lipoma have been reported (Redman JF, Ick KA, North PE. Perineal lipoma and an accessory labial fold in a female neonate. J Urol 2001;166:1450, Sule JD, Skoog SJ, Tank ES. Perineal lipoma and the accessory labioscrotal fold: an etiologic relationship. J Urol 1994;151:475-477). To our knowledge, no other reports of accessory labioscrotal fold with anorectal malformation in the female patient have appeared in the literature. We present our experience of treatment with these rare cases and a review of the literature.     

Pleural lipoma: Report of a case

We report herein the unusual case of a 45-year-old Japanese man whose chest X-rays revealed an abnormal shadow, increasing in size. A chest wall tumor was suspected, based on the findings of computed tomography (CT) of the thorax, the CT number of which was −137, chest roentgenogram, and an echograph. An open biopsy was performed to establish the final diagnosis. The resected tumor was a pedunculated pleural mass, yellowish in color, the pathological diagnosis of which confirmed a lipoma. Intrathoracic lipomas are rare, but pleural lipomas are seen even less frequently. CT, echography, and percutaneous needle biopsy have been found useful for diagnosing intrathoracic lipomas, but these examinations are not always adequate for confirming the final diagnosis. Consequently, tumor resection is essential for obtaining a pathological diagnosis.     

Para-anal lipoma as a rare consequence to perineal trauma. Case-report and review of the literature

Introduction: Lipomas are the most common benign mesenchymal tumors which can be found in any part of the body. Nevertheless, their etiology and pathogenesis remain unknown. It is hypothesized that some of these lesions could result from an acute or chronic trauma.

Patients and methods: We report a case of a 54-year-old man presenting a perineal lipoma which volume grew rapidly after he fell on his buttock, in the context of inaugural epileptic seizure. Pelvic MRI showed a voluminous fatty mass, measuring 6.6?×?5?×?9?cm without any signs of local invasion. Furthermore, we review the latest research on lipomas originating from traumatic lesion.

Results: The mass was completely excised in one block under general anesthaesia, using an elliptical incision and a deep dissection. We did not close the skin incision in view of the cutaneous defect. Post-operative recovery was uneventful and the patient was discharged from hospital two days after the operation. Histopathology indicated a reorganised lipoma with no evidence of malignancy.

Conclusion: Perineal lipomas are extremely rare, pathological examination of imaging guided biopsies are needed to exclude malignancy especially a well-differentiated liposarcoma. MRI remains the first option and radical surgical excision is the gold standard treatment.     

The first case of renal lipoma in a child

Lipoma of the kidney is a rare benign renal tumor that previously had been reported only in adults. We present a case of this tumor in a 2-year-old boy. Serial imaging studies revealed a tumor with high fat content arising from the right kidney. Radical nephrectomy was performed for tumor excision. Macroscopically, the tumor consisted of a yellow fatty mass, which was surrounded by a thin fibrous capsule. The tumor was about 600 g, and the kidney was compressed laterally by the tumor. Microscopically, the tumor consisted of large fat cells that did not express human melanoma black-45 (HMB-45). It was diagnosed as a renal lipoma. Postoperatively, there has been no recurrence of tumor in the 10 months since the surgical excision.     

Perineal burn contractures: An experience in tertiary hospital of a Himalayan State

Perineal burn contracture is a rare burn sequel. We conducted a retrospective analysis of cases with perineal burn contractures managed in a tertiary care centre of a Himalayan state. We found that all cases sustained burn injury from burning firewood and the time of presentation was two to six years after the burn injury. We analyzed our treatment method and have classified these contractures into two types.     

Perineal Pilonidal Sinus after an Antero-posterior Resection of Rectum: Case Report

Introduction : Pilonidal sinus is common in sacroiliac region and occasionally occurs in the interdigital web space.

Method : We describe an unusual case of an acquired implantation pilonidal sinus involving the perineal wound which occurred after an anteroposterior resection of the rectum.

Result/Discussion : This patient was successfully treated by excision of the sinuses. Recognition and treatment of this condition may cure the patient with a persistent post operative perineal sinus.     

Giant intrathoracic lipoma presenting as a lump in the supraclavicular fossa

A 25-year-old man presented with a lump in the supraclavicular fossa. Subsequent investigations showed that the patient had a giant intrathoracic lipoma that has caused the deviation of his trachea to the left and had encased his great vessels. Multidisciplinary discussions concluded that tracheal stenting was most suitable for the patient. We describe details of his presentation, clinical findings and discuss the management options of a giant intrathoracic lipoma.     

Giant omental lipoma in a 13-year-old adolescent girl

Although lipoma is a common benign mesenchymal tumor, its occurrence in the omentum is a rare finding. We report an unusual case of omental lipoma in a 13-year-old adolescent girl. The mass was completely excised and weighed 12.3 kg. The patient is alive and well with no evidence of recurrence at 4 months of follow-up.     

Mediastinal lipoma: Report of a case

We experienced a case of mediastinal lipoma, which is considered to be a relatively rare disease. A 3-year-old girl was referred to Gifu University hospital because of fever and an abnormal shadow on her chest X-ray. The chest X-ray clearly showed a well-delineated tumor shadow which seemed to oppress the diaphragm and the right atrium in the right lower lung area. A computed tomogram (CT) of the chest showed a homogeneous mass localized on the right diaphragm and adjoining the right anterior chest wall and heart. The mass showed a fat density measuring about-100 HU. Magnetic resonance imaging (MRI) showed a high-intensity mass which was almost the same level as the subcutaneous fat on both the T₁-weighted and T₂-weighted images. Thoracotomy was performed and a fatty tumor was found. It arose from the right side of the pericardium and adjoined the diaphragm, the anterior chest wall, and the thymus. There was no adhesion between the tumor and the surrounding organs. It was resected easily and its contents were yellowish and homogeneous. The patient made an uneventful recovery and was discharged 10 days after the operation. Light microscopy showed a lipoma consisting of mature adipose tissue and no malignancy was found.     

Subpleural lipoma: Management of a rare intrathoracic tumor

INTRODUCTIONSubpleural lipomas are rare intrathoracic benign tumors. They are often discovered incidentally on plain chest radiographs and the diagnosis is usually established by computed tomography.PRESENTATION OF CASEWe report a case of subpleural lipoma, with enlargement during a period of two years. Pathology examination of the specimen confirmed the diagnosis of lipoma.DISCUSSIONFor non-invasive diagnostic investigation, computed tomography enables the identification and quantification of subpleural lipoma due to their characteristic fat attenuation. Surgical resection with thoracotomy or VATS provides more accurate and firm diagnosis, and complete excision.CONCLUSIONThis clinical entity needs attention due to difficult preoperative differentiation. Complete surgical excision of these lesions with the appropriate surgical approach is mandatory, for both diagnosis and treatment.     

Video-assisted thoracoscopic resection of a giant anterior mediastinal tumor (lipoma) using an original sternum-lifting technique

We report here the complete thoracoscopic resection of a giant lipoma (18x15x5 cm, 560 g) in a 33-year-old man using an original sternum-lifting technique. The patient had an uncomplicated postoperative course and was discharged on the seventh postoperative day. This is the largest reported anterior mediastinal tumor that was completely resected by video-assisted thoracic surgery without median sternotomy or thoracotomy. This original method may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmetic results for an anterior mediastinal giant tumor.     

Laparoscopic-assisted resection of a gastric lipoma

Laparoscopic excision of a gastric lipoma is reported here. The diagnosis was done preoperatively be computed tomography, which gave evidence of fat tissue due to its low attenuation. The patient undergoes a complete submucosal excision enjoying the benefit of the laparoscopic approach with rapid postoperative recovery. This procedure offers a good alternative to open laparotomy in the treatment of benign gastric tumours.     

Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome

Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.     

Intraosseous lipoma: a clinical study of 12 patients

We studied 12 patients (13 bones) with intraosseous lipoma to elucidate the clinical features of this disease. The patients ranged in age from 14 to 54 years. Eleven patients were men and 1 was a woman. The involved bones were the calcaneus in 6 patients (7 bones), humerus in 3, ischium in 2, and sacrum in 1. Three bones were in Milgram's stage I, 8 were in stage II, and 2 were in stage III. On plain radiographs, all bones showed a well-circumscribed radiolucent area. Nine bones showed calcification or ossification. Computed tomography or magnetic resonance imaging showed low density or high signal intensity, respectively, identical to the findings in normal adipose tissue. The tumor was curetted in 3 patients (3 bones), in whom local recurrence was not seen thereafter. In the remaining 9 patients (10 bones), we observed the natural course; in 1 of these patients, incisional biopsy was performed. During the follow-up period, only 1 patient showed slight enlargement of the lesion, while the findings in the others remained unchanged. Three patients had pain, which disappeared after the surgery or during the course of the observation. Partly because intraosseous lipoma tends to undergo spontaneous involution, and partly because diagnosis is easy from the radiological findings, surgery does not seem to be necessary in most patients. Received: August 6, 2001 / Accepted: October 30, 2001     

Perineal anastomotic urethroplasty for managing post-traumatic urethral strictures in children: the long-term outcome

OBJECTIVE

To evaluate the long‐term results of one‐stage perineal anastomotic urethroplasty for post‐traumatic paediatric urethral strictures.

PATIENTS AND METHODS

Thirty‐five boys who had a perineal anastomotic urethroplasty for post‐traumatic bulbous or posterior urethral strictures between 1991 and 2003 were analysed retrospectively. Patients were followed up for a mean (range) of 46 (6–132) months by a history, urinary flow rate estimate, retrograde urethrography and voiding cysto‐urethrography.

RESULTS

The mean (range) age of the patients was 11.9 (6–18) years. The estimated radiographic stricture length before surgery was 2.6 (1–5) cm. The perineal anastomotic repair was successful in 31 of 35 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in two patients and by repeat perineal anastomotic repair in the remaining two, giving a final success rate of 100%. All boys are continent except two who had early stress incontinence, and that resolved with time. There was no chordee, penile shortening or urethral diverticula during the follow‐up.

CONCLUSIONS

The overall success of a one‐stage perineal anastomotic repair of post‐traumatic urethral strictures in boys is excellent, with minimal morbidity. Substitution urethroplasty or abdomino‐perineal repair should be reserved for the occasional patients with concomitant anterior urethral stricture disease or a complex posterior urethral stricture, respectively.

     

Intraosseous lipoma of the fifth metatarsal: a case report

Intraosseous lipomas are benign tumors of bone. Although the tumor may affect many different locations, small bone involvement is quite rare. The authors report a case of an intraosseous lipoma of the fifth metatarsal treated with curettage and packing with allograft. The clinical and laboratory features of the case are also discussed.