Liposarcoma of Spermatic Cord - A Rare Entity

Case Report

Liposarcoma of spermatic cord e A rare entity

Pravin Govardhane a, Feroz Amir Zafar a, Ishfaq A. Geelani a, H. Girish a,D.V.S.L.N. Sharma a, V. Rajagopal a,*, Meenakshi Swain b, G. Swarnalatha b

aDepartment of Urology, Apollo Hospitals, Hyderabad, IndiabDepartment of Histopathology, Apollo Hospitals, Hyderabad, India

a r t i c l e i n f o

Article history:

Received 31 January 2013

Accepted 31 January 2013

Available online 6 February 2013

Keywords:

Liposarcoma

Spermatic cord tumors

Paratesticular liposarcoma

Myxoid liposarcoma

a b s t r a c t

Introduction and objective: Liposarcoma of the spermatic cord is a rare entity with only two

series and less than 100 cases reported in literature. We report a case of a giant liposarcoma

of the spermatic cord.

Case report: A 65-year old man presented with a 2-year history of a progressive painless

swelling in the right lower quadrant of the abdomen. He gave a past history of right

inguinal hernia repair and excision of a mass lesion of the spermatic cord 15 years back

(? nature; no HPE report available). Local examination revealed a large smooth solid mass

about 20 � 12 cm in the right iliac fossa and pelvis, firm, non-tender and mobile from side

to side. Testes were normal. USG revealed a non-homogenous and hyper echoic. CECT

showed a 21 � 11.2 cm well defined mass lesion with mixed densities (18 HU) and minimal

enhancement with contrast present in the right iliac fossa and pelvic region. On explora-

tion, a lipomatous mass was found arising from the inguinal portion of spermatic cord.

Radical orchiectomy with wide local excision was carried out. Histopathological exami-

nation of the resected specimen showed a well differentiated liposarcoma of the spermatic

cord (myxoid variant). Margins were negative. Patient was advised long-term follow up in

view of high recurrence rate.

Conclusion: Liposarcoma of the spermatic cord is rare. Surgical treatment is the manage-

ment of choice with Radical orchiectomy and wide local excision. Adjuvant radiation

should be given if margin status is in doubt. High incidence of local recurrence mandates

a long period of follow up.

Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.

1. Introduction

Malignant lesions of the spermatic cord are rare with only

around 100 cases reported in the world literature.1 Lip-

osarcoma of spermatic cord is a rare entity and only few cases

have been reported in literature.

Sarcomas of the spermatic cord, epididymis, and testis are

the most common genitourinary sarcomas in adults.

Liposarcoma is themost commonhistologic subtype in adults,

followed by rhabdomyosarcoma, leiomyoma, malignant

fibrous histiocytoma, and fibrosarcoma.2

Sarcomas are most often in the intrascrotal region and

primary mesenchymal tumors of the testis are uncommon.

These tumors usually present as a painless, palpable mass,

and most are large (>5 cm). Sarcomas should be managed

initially through an inguinal approach with wide excision of

* Corresponding author.E-mail address: raja_urol@rediffmail.com (V. Rajagopal).

Available online at www.sciencedirect.com

journal homepage: www.elsevier .com/locate /apme

a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 8 2e8 4

0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2013.01.017

the spermatic cord and testis with high ligation.3 Lip-

osarcomas rarely metastasize but tend to recur locally.4

We report a case of a giant liposarcoma of the spermatic

cord.

2. Case report

A 65-year old man presented with a 2-year history of a pro-

gressive painless swelling in the right lower quadrant of the

abdomen. He gave a past history of right inguinal hernia repair

and excision of a mass lesion of the spermatic cord 15 years

back (? nature; no HPE report available).

Local examination revealed a large smooth solid mass

about 20 � 12 cm in the right iliac fossa and pelvis, firm, non-

tender and mobile from side to side (Fig. 3). Testes were

normal.

Routine blood investigations were within normal limits.

USG revealed a non-homogenous and hyper echoicmass in

right iliac fossa.

CECT showed a 21 � 11.2 cm well defined mass lesion with

mixed densities (18 HU) and minimal enhancement with

contrast present in the right iliac fossa and pelvic region (Figs.

1 and 2).

Inguinal exploration was done. We found a large lip-

omatous mass arising from the right inguinal cord (Fig. 4). We

performed a Radical orchiectomy with wide local excision.

Mass was sent for histopathological examination.

Histopathological examination of the resected specimen

showed a well differentiated liposarcoma of the spermatic

cord (myxoid variant) as shown in Figs. 5 and 6. Margins were

negative.

3. Discussion

Lesauvage reported the first case of sarcoma of spermatic cord

in 1845.5

Most patients present in their 50s or 60s in the form of

a slow-growing inguinal or inguino-scrotal mass and they can

be mistaken for inguinal hernia or lipoma and CT or MRI is

Fig. 1 e CECT pelvis showing mass in iliac fossa with

mixed density.

Fig. 2 e CECT of pelvis showing mass in iliac fossa with

minimal enhancement on contrast.

Fig. 3 e Mass in right lower abdomen.

Fig. 4 e Large tumor dissected through inguinal

exploration.

a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 8 2e8 4 83

helpful to distinguish between these entities. Embryonal

rhabdomyosarcoma is the most common histologic subtype

in men younger than age 30.3

A relatively higher incidence of this cancer has been

reported in Japanese men (nearly one-fourth of the reported

cases) but the cancer is known to occur all over the world.3

Liposarcoma accounts for 5e7% of paratesticular

sarcomas.2

Liposarcoma are further subdivided into 4 types, including

well differentiated, myxoid, round-cell, and pleomorphic.

Myxoid variety is the most common type and account for

about 50% of all liposarcomas.

Inguinal radical orchiectomy is the standard approach for

sarcomas of spermatic cord with wide resection margins.6

Some authors favor a hemiscrotectomy in addition to the

inguinal orchiectomy.7

Local recurrence can occur in upto 50% patients.8

Since negative margin status can rarely be ensured, some

authors recommend adjuvant radiation9 although the efficacy

of this approach is debated. The long-term survival of men

with paratesticular sarcoma is approximately 50%.

4. Conclusion

� Liposarcoma of the spermatic cord is rare

� Surgical treatment is the management of choice with Rad-

ical orchiectomy and wide local excision

� Adjuvant radiation should be given if margin status is in

doubt10

� High incidence of local recurrencemandates a long period of

follow up

� This is perhaps a recurrent liposarcoma of the spermatic

cord

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Chintamani, et al. Liposarcoma of the spermatic cord:a diagnostic dilemma. JRSM Short Rep. 2010 November;1(6):49.

2. Stephenson Andrew J, Gilligan Timothy D. Tumors of Testis. In:Campbell-Walsh Urology. 2010;31:869e870.

3. Coleman J, Brennan MF, Alektiar K, et al. Adult spermatic cordsarcomas: management and results. Ann Surg Oncol.2003;10:669e675.

4. Montgomery E, Fisher C. Paratesticular liposarcoma:a clinicopathologic study. Am J Surg Pathol. 2003;27:40e47.

5. Hinman F, Gibson TE. Tumor of the epididymis, spermaticcord and testicular tunics: a review of literature and report ofthree new cases. Arch Surg. 1924;8:100.

6. Wilson N, Davis A, Bell R, Wilson AN, Davis A, Bell RS. Localcontrol of soft tissue sarcoma of the extremity: theexperience of a multidisciplinary sarcoma group withdefinitive surgery and radiotherapy. Eur J Cancer. 1994;30:746.

7. Blitzer PH, Dosoretz DE, Proppe KH. Treatment of malignanttumors of the spermatic cord: a study of 10 cases and reviewof literature. J Urol. 1981;126:611e614.

8. Pisters PW, Leung DH, Woodruff J. Analysis of prognosticfactors in patients with localized soft tissue sarcomas. J ClinOncol. 1996;14:1679.

9. Ballo MT, Zagars GK, Pisters PW. Spermatic cord sarcomas:outcome, patterns of failure and management. J Urol.2001;166:1306e1310.

10. Fagundes MA, Zietman AL, Althausen AF. The managementof spermatic cord sarcoma. Cancer. 1996;77:1873.

Fig. 5 e Histopathological pictures of well defined

liposarcoma of spermatic cord (myxoid variant).

Fig. 6 e Histopathological pictures of well defined

liposarcoma of spermatic cord (myxoid variant).

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