different disturbances of body fat distribution have been previously described and published [ 1 , 2 , 3 ] . some are associated with a complete or partial loss of adipose tissue such as lipodystrophy in the case of insulin - dependent diabetes or in patients with hiv and anti - retroviral therapy . besides lipomas and the multiple symmetric lipomatosis ( madelung s disease ) , lipomatosis of different sites can be found [ 3 , 4 , 5 , 6 ] .
a preoperative workup is essential for the right differential diagnosis and the right therapy . here
we present a rare case of lipomatosis of the perineum as an example of an unusual localization of a lipoma .
we present a 58-year - old man who was suffering from a painful localized lipomatosis of the perineum , close to the scrotum .
the patient reported slow growth over 45 years . during this period , the patient s weight was constant ( patient s weight 90 kg , height 180 cm , body mass index 27.8 ) .
the only known comorbidity was parkinson s disease , which was treated with a dopamine agonist , monoamine oxidase inhibitor and a selective norepinephrine reuptake inhibitor .
the patient was a non - smoker , non - alcoholic , with family history being unremarkable .
his physical examination showed normal physical findings , except for a soft tumor of 5  5  4 cm in the perineum , impressing like labia majora , located dorsal to the scrotum ( figure 1 ) . clinical examination and ultrasound revealed no inguinal or intra - abdominal lymphadenopathy .
routine biochemical investigation , including hematology , liver function tests and renal function tests revealed no abnormalities .
computed tomography ( ct ) showed tumor formation without a capsular structure or definite border .
it suggested that the tumor was benign and consists of fat ( figure 2 ) . 

preoperative computed tomography scan : lipid formation without any capsular structure in the perineum . 
 
surgical removal was performed in lithotomy position . through a 5 cm cut in the perineum ,
220 g of macroscopically inconspicuous adipose tissue was removed in small portions ( figure 3 ) .
wound closure was performed with deep dermal interrupted vicryl ( 3/0 ) sutures and dermal running lock stitch ethilon ( 4/0 ) sutures .
dermal sutures were removed 14 days postoperatively . during this period , no sports were allowed . 

the histological examination of the tumor revealed fatty tissue with univacuolar adipocytes and formations of fibrous septa and smooth muscles , consistent with an unspecific benign lipomatosis ( figure 4 ) . 

histological figure ( hematoxylin and eosin staining ) with univacuolar adipocytes , fibers of smooth muscle cells and fibrous fibers . 
 
in clinics , plastic surgeons are often confronted with lipomatosis or soft tissue tumors at different sites [ 3 , 4 , 5 , 6 ] .
diagnosis can often be easily made by physical examination or ultrasound ( e.g. , subcutaneous lipoma ) and in some cases liposuction leads to satisfying results [ 7 , 8 ] .
it is important to differentiate between cases with symmetric lipomatosis or lipomas and patients with soft tissue enlargements that require more attention . in our case , a patient presented with a painful , slowly growing soft tumor in the perineum
lipomatous tumors or lipomatosis of the perineum are very rare and have not been broadly published .
presented a case of lipomatosis of the penis and the perineum in a 6-year - old boy .
pelvic lipomatosis is an uncommon benign disease of unknown etiology that was first described by engels in 1959 .
magnetic resonance imaging ( mri ) can help to accumulate information on tumor size , dimension , surrounding structures and sometimes suggested dignity , which is necessary in the workup of soft tissue tumors .
we usually perform mri scan in all patients with soft tissue tumors larger than 2 cm and with tumors located in deeper tissue layers ( e.g. , intramuscular localization ) .
the ct scan revealed a lipoma formation without any capsular structure in the perineum . there is a long list of differential diagnoses of atypical lipomatous tumors , which ranges from lipoblastoma , spindle cell lipoma , pleomorphic liposarcoma to benign lipomatosis of unknown origin .
inconspicuous fatty tissue can often be removed by liposuction . however , before starting the treatment a tissue specimen has to be taken in cases of unclear dignity .
the exact operative procedure depends on the dignity , tumor size , its dimension and surrounding structures . in our case
, ct of the tumor revealed that it was located subcutaneously , without breaking into deeper layers .
surgical excision provided symptom relief and potentially prevented tumor expansion . the histological examination of the tumor confirmed that it was composed of adipose tissue .
patient s weight during the time of tumor growth was constant and no medical drugs ( like steroids , where a gain of fat is described ) were taken .
furthermore , hormone and lipid levels of the patient were normal . in literature , a few case reports of soft tissue tumor development after previous traumatic injury have been reported .
we found no data that correlated bicycle riding , not even in professional sports , and lipomatous tissue enlargement in the perineum .
we can state that no topical or irritative reasons could be found in this case . in summary ,
we present the case of a 58-year - old man with fatty tissue in the perineum of unknown origin . as with many other published cases , no cause for this enlargement
however , before surgical treatment , one must be aware of possible differential diagnoses and rare etiological factors . in our case , surgical excision of the tumor
 abstractlipomatosis of the perineum is an extremely rare condition . 
 we report a localized hypertrophy of adipose tissue of the perineum in a 58-year - old man . the cause of enlargement could not be revealed . 
 nonetheless , preoperative workup and exclusion of possible malign tumors is essential . 
Introduction
Case report
Discussion