Introduction

Spindle cell lipoma (SCL) is a benign mesenchymal neoplasm first described in 1975 by Enzinger and Harvey as a subtype of lipoma (1). It typically presents as a slow-growing, painless subcutaneous mass, most often in middle- aged to elderly men. Common sites include the posterior neck, shoulder, and upper back, while rare manifestations have been reported in the oral cavity, parotid gland, breast, and extremities (2, 3). SCL involving the inguinal canal is particularly uncommon and may clinically mimic inguinal hernias, liposarcomas, or lymphadenopathies, posing diagnostic difficulties both clinically and radiologically.

Accurate diagnosis of SCL relies on histopat-hological and immunohistochemical features that distinguish it from other soft-tissue tumors. Characteristic features include uniform spindle cells, mature adipocytes, and dense collagen bundles, typically expressing CD34 while being negative for S‑100, Desmin, and other lineage markers (4). In this report, we present a rare case of inguinal SCL in a 68‑year‑old man, initially misinterpreted as a probable hernia. The lesion was surgically excised and confirmed histologically as SCL. Notably, follow‑up imaging demonstrated complete resolution without recurrence, emphasizing the benign behavior of the tumor and the value of comprehensive diagnostic evaluation.

Case Presentation

A 68‑year‑old man presented to the surgical clinic with a 2–3‑month history of a right inguinal swelling extending into the scrotum. The patient reported progressive enlargement of the mass, which reduced in the supine position but reappeared when standing or during physical activity. He also complained of lower abdominal discomfort and urinary symptoms, including weak stream, frequency, dysuria, and nocturia. He was receiving tamsulosin at the time of assessment. His past medical history included type 2 diabetes mellitus and ischaemic heart disease (post‑angioplasty one year earlier). He had previously undergone three transurethral lithotripsy (TUL) procedures. There was no history of drug allergy, family history, or other systemic illness. On examination, a non‑tender, soft mass was palpable in the right inguinal canal without signs of inflammation. Scrotal contents were otherwise normal, and no features of inguinal or femoral hernia were noted.

Baseline laboratory investigations, including CBC, renal function tests, PSA, and urinalysis, were unremarkable except for 2+ blood in the urine. Tumour markers were within normal limits. Further imaging was conducted. CT of the abdomen and pelvis with contrast revealed a soft‑tissue lesion measuring approximately 50 × 38 mm in the right inguinal canal, surrounded by fat stranding but without lymphadenopathy or solid‑organ involvement. Scrotal ultrasound and inguinal Doppler demonstrated no hernia and no significant lymph node enlargement, though a few small reactive nodes (<12 mm) were observed. Similarly, pelvic MRI showed no abnormalities in the pelvic organs, vasculature, or bony structures (Figure 1). A bone scan excluded osseous metastasis.

Figure 1: Pelvic MRI showing no abnormalities in the pelvic organs, vasculature, or bony structures.