Nodule on the scrotum

A 39-year-old Sikh businessman of Asian origin was referred to us with complaints of a painless scrotal lesion that had enlarged over a 2-year period and was causing him discomfort. There was no history of trauma, inflammation, or infection, and no significant urologic history. Physical examination revealed a 2x2 cm skin-colored nodule of rubbery consistency on the left side of the scrotum (Figure 1), which was separate from the testicles or epididymis. There was no inguinal lymphadenopathy. Scrotal ultrasonography demonstrated that the testicles and epididymis were normal. The scrotal mass and surrounding skin were surgically resected using a vertical elliptical incision and sent for histopathology. Histologic examination was consistent with leiomyoma. The epidermis was normal with a prominent proliferation of intertwined smooth muscle fibers with interlacing collagen bundles in the dermis. At higher magnification, the cells were spindle-shaped with eosinophilic cytoplasm and long nuclei. These interweaving bundles of cells surrounded the vessels and the pilosebaceous apparatus. There was no evidence of atypia and the mitotic index was low (Figure 2 and Figure 3). Some normal dartoic muscle fibers were seen in the periphery of the tumor. The patient's postoperative recovery was uneventful. On follow-up visit 10 days later, he did not have any complications, and the sutures were removed. At his last visit 6 months after the procedure, he was still asymptomatic and did not have any recurrence.