Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2011  |  Volume : 22  |  Issue : 6  |  Page : 1205--1207

Liposarcoma of spermatic cord


Ammar Fadil Abid 
 Al Mustansiriyah Medical College, Urologist, Al Yarmouk Teaching Hospital, Baghdad, Iraq

Correspondence Address:
Ammar Fadil Abid
Al Mustansiriyah Medical College, Urologist, Al Yarmouk Teaching Hospital, Baghdad
Iraq




How to cite this article:
Abid AF. Liposarcoma of spermatic cord.Saudi J Kidney Dis Transpl 2011;22:1205-1207


How to cite this URL:
Abid AF. Liposarcoma of spermatic cord. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Dec 11 ];22:1205-1207
Available from: http://www.sjkdt.org/text.asp?2011/22/6/1205/87234


Full Text

 Introduction



Liposarcoma of the spermatic cord is rare. It originates in the spermatic cord adipose tissue and is composed of adipose cells, fibroblasts, and myxomatous cells. Liposarcomas usually occur in patients older than 40 years. The differential diagnosis is not easy and liposarcomas are often mistaken for incarcerated hernia.

Ultrasound is useful for differentiation from cystic or solid lesions. Often, the nature of the mass is recognized only at surgery. Radical orchiectomy with high cord ligation is the treatment of choice. Hematogenous or lymphatic spread is usually a late event in high grade tumors. To the best of our knowledge, in literature, approximately 200 cases have been described. A case of dedifferentiated liposarcoma of spermatic cord is reported.

 Case Report



A 65-year-old male patient was admitted to our division, who presented with a large right-sided painless scrotal mass. The heaviness was the main complaint. The patient had noticed the mass over a year. Blood chemistry, electrocardiogram, and chest X-ray were normal.

Clinical examination revealed a painless scrotal mass, irregular in shape but nearly ovoid, measuring about 15 × 8 cm, hard in consistency and adjacent to the external inguinal ring. The mass was felt separate from the normal palpable right testis, with intact overlying scrotal skin. Ultrasound findings revealed hyperechoic, heterogeneous lesions that were considered suggestive of malignancy. [1]

Surgery was therefore planned. The skin was incised through the right inguinal access. After high ligation of the spermatic cord, the whole mass was delivered through the wound. A well-circumscribed hard mass was found attached to spermatic cord. However, it was separated from normal looking epididymis and testis. Radical orchiectomy done with resection of spermatic cord at the internal inguinal ring. The post operative period was smooth. The patient was discharged on day one itself in good general condition.

A histologic examination revealed de-differentiated liposarcoma in which a variety of "heterogonous" lines of differentiation, including osseous, vascular, skeletal, and/or smooth muscular elements may be seen.

No further procedures were done and the patient followed-up for three months showed no recurrence or progression of tumor.

The histological findings included:

Macroscopic evaluation: testicular specimen measuring 4 × 2.5 cm with spermatic cord measuring 3 × 0.5 cm and an attached solid, apparently well-capsulated circumscribed mass measuring (14 × 8 × 5cm) [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

The cut section of the mass revealed a soft yellow area alternating with bony hard nodules.

Microscopic features [Figure 3] section shows lipoplastic proliferation, myxoid changes, and metaplastic bone formation associated with malignant looking spindle cells and multinucleated giant cells.{Figure 3}

 Discussion



Paratesticular malignancies and sarcomas of the seminal cord are rare. Eighty percent of seminal cord tumors are benign and mostly derived from lipomatous tissue. Most paratesticular malignant tumors are sarcomas. The spermatic cord is the most commonly involved urologic site and accounts for approximately 30% of all genitourinary sarcomas. [2] On histologic examination, liposarcomas of the spermatic cord and of the scrotal area show essentially the same features as those described in other soft tissue sites, although most of the recorded cases mentioned previously were predominantly characterized as well differentiated. [3]

Although lipomas are the predominant benign tumors found in the inguinal region, lipomatous tissue plays a minor role in seminal cord malignancies, comprising only approximately 5%-7% of all spermatic cord sarcomas. There are only two series that reported in the literature that hypothesized that a mesenchymal origin rather than malignant transformation of lipomatous cells lead to liposarcomas. [3],[4] In contrast to other sarcomas of the seminal cord, metastatic disease of liposarcomas has not been reported. [3],[5],[6]

In most cases, they appeared as a discrete nodular mass, sometimes attaining a large size and frequently located near the spermatic cord, entirely separate from the testicle. [5],[7]

Patients present with a scrotal mass, which is usually not associated with any inguinal complaints. Increase in size slowly over a period of months or years is the usual presentation. Liposarcoma is usually a disease of the older age group. [6],[8]

The general guidelines of sarcoma therapy, a radical surgical excision of any tumor, is necessary. The inguinal radical orchiectomy is the standard approach for sarcomas of the seminal cord in general with wide resection margins. [7]

In conclusion, dedifferentiated liposarcoma of the spermatic cord is rare, and a preoperative diagnosis was difficult. This commonly presents as hard palpable mass of the inguinal canal or scrotum separated from testis. Usually occurs in patients older than 40 years. This is treated by radical inguinal orchiectomy. Complementary radiochemotherapy is not of any use.

References

1Cardenosa G, Papinicolaou W, Fung CY, et al. Spermatic cord sarcomas: Sonographic and CT-features. Urol Rad 1990;12:136.
2Frank I, Takahashi S, Tsukamoto T, Lieber MM. Genitourinary sarcomas and carcinosarcomas in adults. In: Vogelzang NJ, Shipley WU, Scardino PT, Coffey DS, eds. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2000:1110-3.
3Schwartz SL, Swierzewski SJ, Sondak VK, Grossmann HB. Liposarcoma of the spermatic cord: Report of 6 cases and review of the literature. J Urol 1995;153:154-7.
4Ballo MT, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol 2001;166:1306-10.
5Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Tumors of testicular adenxia, In: Wein: Campbell-Walsh Urology, 9th ed. Saunders, An Imprint of Elsevier, 2007:934-6.
6Allaparthi S. Liposarcoma of the spermatic cord: A case report and review of the literature. Internet J Urol 2007;4:2.
7Coleman J, Brennan MF, Alektiar K, Russo P. Adult spermatic cord sarcomas: Management and results. Ann Surg Oncol 2003;10:669-75.
8Wilson N, Davis A, Bell R, et al. Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy. Eur J Cancer 1994;30:746.