What happens and why does a lipoma form?
The spermatic cord is a bundle of the vas deferens, vessels, nerves and membranes, surrounded by loose fatty tissue. A lipoma grows from this fiber: mature fat cells form a limited node in a thin capsule. The exact cause is unknown; a certain role is played by the hereditary tendency to form lipomas of different localizations. Growth is usually very slow, lasting for years. Separately, there is a so-called cord lipoma, which surgeons find during hernia repair: this is a fatty protrusion extended through the inguinal canal, and it is also customary to remove it.
- Source - adipose tissue of the spermatic cord
- The node is soft, in a thin capsule
- Grows slowly over the years
- Most often unilateral
- May be associated with inguinal hernia
Symptoms
A small lipoma is usually not felt at all. As a man grows, he notices a soft, painless formation at the root of the scrotum or in the groin, which can be moved with his fingers. Unlike a hernia, it does not increase with straining and coughing and does not move into the abdomen. A large lipoma can give a feeling of heaviness, rub when walking and interfere with physical activity. Pain is not typical for lipoma: if it appears, other causes must be excluded.
- A soft, moving knot in the groin or at the root of the scrotum
- No pain in the early stages
- The size does not change when coughing and straining
- Feeling of heaviness with a large formation
- Discomfort when walking and exercising
How is it different from an inguinal hernia and other formations?
An inguinal hernia is an exit of the abdominal organs through a weak spot in the anterior wall of the abdomen, so it enlarges while standing and when straining, it is often reduced and can be pinched. The lipoma is not associated with the abdominal cavity and behaves the same in any position. A spermatic cord cyst on ultrasound looks like a fluid cavity rather than fatty tissue. An alarming option is liposarcoma: it grows faster, is denser and has a heterogeneous structure. The final question is resolved by histological examination.
- Hernia - increases with straining and coughing
- Funicular cyst - fluid cavity on ultrasound
- Subcutaneous tissue lipoma lies more superficially
- Enlarged lymph node - denser and associated with inflammation
- Liposarcoma - rapid growth and heterogeneous structure
Diagnostics
They start with an examination in a lying and standing position, with a straining test - this immediately cuts off most hernias. Then an ultrasound of the scrotum and inguinal canal with Doppler ultrasound is performed: the lipoma looks like a homogeneous formation of fatty density with poor blood flow. For large or unusually structured nodes, the doctor may order an MRI to assess the boundaries and connection with surrounding tissues. During the operation, the material is necessarily sent for histological examination, which confirms its benign nature.
- Inspection and palpation in standing and lying positions
- Straining test to exclude a hernia
- Ultrasound of the scrotum and inguinal canal with Dopplerography
- Ultrasound of soft tissues of the groin area
- MRI for large and atypical formations
- Histological examination of the removed node
Treatment and observation
A small lipoma that does not grow and does not interfere can simply be observed with a control ultrasound. Indications for surgery include increased size, discomfort, cosmetic inconvenience and any doubts about the diagnosis. Removal is performed through a small incision in the groin area, usually under local or spinal anesthesia; the surgeon carefully isolates the node without damaging the vas deferens and testicular vessels. If there is an inguinal hernia at the same time, it is removed in the same operation. Traditional methods, ointments and injections do not remove lipoma.
- Observation for small asymptomatic lipomas
- Surgical removal for growth and complaints
- Simultaneous repair for concomitant hernia
- Mandatory histology of the removed material
- Return to exercise after 2–4 weeks as directed by your doctor.
- Ointments and “absorbable” agents are ineffective
