Rare case of a scrotal leiomyoma-a diagnostic dilemma: A case report

Leiomyomas are rare benign mesenchymal tumors originating from smooth muscle cells. Scrotal leiomyomas, in particular, are exceptionally rare, with a prevalence rate of 1 in 1000 among all scrotal tumors.

This case Report has been Reported in line with SCARE Criteria.

A 55-year-old Caucasian male presented with a five-year history of painless scrotal swelling, gradually increasing in size. Clinical examination revealed a non-tender oval lump on the right hemiscrotum. The right testis and cord structures were distinguishable from the mass. While the initial clinical assessment was suggestive of a sebaceous cyst, further evaluation was performed. A wide local excision of the lump was performed and sent for histopathological evaluation. Microscopy indicated a well-circumscribed, non-atypical leiomyoma with no necrosis or increased mitosis, providing us with a definitive diagnosis.

Scrotal leiomyomas are a rare subset of genital leiomyomas, mostly found in middle-aged Caucasian men. Pathological examination is the mainstay to distinguish these tumors into typical and atypical leiomyomas, impacting treatment decisions. Simple surgical excision is curative, and Irradiation is contraindicated.

Scrotal leiomyomas should be considered in the differential diagnosis of scrotal masses. This case emphasizes the necessity of wide local excision, with adequate clearance, and regular follow-up to rule out recurrence, particularly given the potential for atypia and progression to leiomyosarcoma. The prognosis overall is good as recurrence rates are low.