Peritesticular lipoma

Last revised by Ryan Thibodeau on 15 Jul 2024

A peritesticular lipoma, or lipoma of the spermatic cord, is the most common benign tumor of the paratesticular tissues and spermatic cord (representing ~45% of paratesticular masses 4).

The term 'spermatic cord lipoma' is variably used to mean a true lipoma of the spermatic cord (originating from adipose cells and with no communication with the inguinal canal), or in surgical literature referring to intraperitoneal fat extending through the inguinal canal 5.

Usually an incidentally discovered non-tender soft scrotal mass 4.

Typically a well-circumscribed, homogeneous, hyperechoic, and relatively avascular mass 4,6.

The absence of communication with the inguinal canal, reducibility, and bowel content/peristalsis help to differentiate from an inguinal hernia or lipoma, although a strangulated or incarcerated hernia may be aperistaltic and irreducible 4. The presence of a poorly circumscribed mass, heterogenous echotexture, or vascularity, should raise the possibility of liposarcoma 4,5.

While sometimes an incidental finding, this modality may also be used to help evaluate lesions with unclear or concerning characteristics on ultrasound 5,6. Characteristic homogenous, circumscribed fat attenuation, without inguinal canal communication or contrast enhancement, may be appreciated 5.

  • T1: homogenous high signal intensity due to fat 4,7

  • T1 C+: no enhancement 7

Cases and figures

  • Peritesticular lipoma

Imaging differential diagnosis

  • Spermatic cord liposarcoma
  • Spermatic cord liposarcoma
  • Inguinal hernia
  • Lipoblastoma - inguinal canal
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