楊哲學、林益聖、許兆畬、歐宴泉、童敏哲

童綜合醫院 外科部 泌尿科

Che-Hsueh Yang, Yi-Sheng Lin, Chao-Yu Hsu, Yen-Chuan Ou, Min-Che Tung Division of Urology, Department of Surgery, Tung’s MetroHarbour Hospital,Taichung

Taiwan

 

Case: A 24-year-old unmarried man came to our out-patient department with complaints of several nodules in dorsal and ventral prepuce. These nodules had existed for a year and the size was progressive. The maximal diameter was 5 cm in length. He did not complaint difficultiy on urination. No pain on urethra was noted. No pain during erection was mentioned. Generally, the penis was looked aesthetically dysmorphics with ventral curvature. On physical examination, the prepuce was swelling and thick. These nodules were in rubber-like non-tender characteristic, and fixed firmly. There were no obvious abnormalities in blood data. Ketamine was also negative. Under ultrasound, the testes and epididmyes were in normal size and shape. Normal cavernosa and spongiosa urethra were ensured. Neither varices nor hydroceles was detected. No obvious herniation was found. At prepuce and left scrotum, several superficially vascular nodules were found. Excisional biopsy was performed. The excised tumor was 4.6 x 2.6 x 1.5 cm in size. Microscopically, it consisted of mature large clear fat cell and fibrous tissue. The vascular congestion was also observed. No malignant cells could be found by pathology. Thus, on the basis of pathological specimen, the penile subcutaneous fibrolipoma was diagnosed.

Discussion: The fibrolipoma, which is present as the mature adipose tissues with prominent bundles of mature fibrous tissues traversing fatty lobule, is one of the entities of lipoma and a rarely observed subtype. Overall, lipoma consisted of 5% of soft tissue tumor. 40% was occurred in trunk, 35% in limbs, 15% in the each hand, and 1%-5% in the head and neck and oral cavity. For the anatomical characteristics of penis, fat tissues are absent from all layers structure. In this way, development of the fibrolipoma is especially extremely rare. To our knowledge, by searching through the major medical databases, such as Medline, PubMed, and ClinicalKey, this is the first case report at least during the past 20 years on this topic in Taiwan. Just like lipoma, the clinical course of a typical fibrolipoma is long and slow. Some certain risk factors may be imparted, such as chronic infection, hormone, trauma history, gene( familial multiple lipomatosis) and so on. In the most occasions, it is a benign type of tumor, but some papers, mostly from case reports, do observe the malignant change. Thus, turning into malignancy or not is still under debate. The clinical symptoms are often resulted from where it caused the mechanical compressions on the anatomical structures. For the most fibrolipomas grow outwards, thus bare articles mention about urethral obstruction. Like this case, penile shaft fibrolipoma, from the articles we review, the most bothering issues are sexual dysfunction and its associated psychogenic problems, and aesthetical changes on the penis appearance. In the settings of diagnosis, besides bedsides physical palpation, the most handy and useful tool is the ultrasound device. There are papers proposing that MRI may help differential diagnosis on the malignancy, distinguishing the surrounding anatomical structures, and help stratifying in operation procedure. In the most cases, a simple surgical excision is enough, no matter in confirming the diagnosis, improvement on aesthetical appearance, and restoring the sexual intercourse abilities. If the patients are severely caused aesthetic dysmorphophobia by it, there is an issued case report suggesting that the augmentative phalloplasty is a safe and effective operation and may provide help to them.