Perineal accessory scrotum with a lipomatous hamartoma in an adult male
A 46-year-old male patient was admitted to Dongguk University Gyeongju Hospital because of a perineal mass. The patient was born with the mass but he didn't undergo any treatment. There was no history of rapid growth or other complications. Recently, he has felt discomfort from the mass, especially during defecation. He was a hepatitis B virus carrier and he had a 20-year history of rheumatoid arthritis. Physical examination revealed a round, pedunculated mass arising from the left lateral aspect of the anus. The mass was soft, nontender and movable, measuring 5 cm × 4 cm. There was a 3.5 cm × 1.5 cm sized elongated skin-tag-like protuberance on the left lateral portion of the main mass. The rugated skin of the protuberance was contiguous with the covering skin of the main mass. Anal sphincter was normal. There were no abnormalities in the anorectal and genitourinary system. Under the impression of a lipoma, we completely excised the mass. On section, the main mass was a lump of ill-defined yellow adipose tissue partly divided by whitish fibrous septa. The elongated small protuberance was composed of whitish soft tissue and had a rubbery texture (). At the junction of the two lesions, adipose tissue was intermingled with whitish soft tissue of the small nodule. Microscopically, the main mass consisted of predominant mature adipose tissue that was neither encapsulated nor well circumscribed from surrounding tissue (). Small bundles of bland smooth muscle fibers, mature neural tissue and blood vessels were scattered within the adipose tissue mass (). Atypical cells or malignant cells were absent. The main mass was diagnosed as a hamartoma with predominant adipose tissue (lipomatous hamartoma). The skin-tag-like protuberance was composed of numerous, irregularly oriented smooth muscle bundles, resembling the tunica dartos (). It was confirmed as an accessory scrotum. The perineal mass was diagnosed as perineal accessory scrotum with a lipomatous hamartoma. There was neither postoperative complications nor functional sequelae.