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Available online at www.sciencedirect.com
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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
a
b
Department of Urology, Apollo Hospitals, Hyderabad, India
Department of Histopathology, Apollo Hospitals, Hyderabad, India
article info
abstract
Article history:
Introduction and objective: Liposarcoma of the spermatic cord is a rare entity with only two
Received 31 January 2013
series and less than 100 cases reported in literature. We report a case of a giant liposarcoma
Accepted 31 January 2013
of the spermatic cord.
Available online 6 February 2013
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
Keywords:
inguinal hernia repair and excision of a mass lesion of the spermatic cord 15 years back
Liposarcoma
(? nature; no HPE report available). Local examination revealed a large smooth solid mass
Spermatic cord tumors
about 20 Â 12 cm in the right iliac fossa and pelvis, firm, non-tender and mobile from side
Paratesticular liposarcoma
to side. Testes were normal. USG revealed a non-homogenous and hyper echoic. CECT
Myxoid liposarcoma
showed a 21 Â 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 exploration, a lipomatous mass was found arising from the inguinal portion of spermatic cord.
Radical orchiectomy with wide local excision was carried out. Histopathological examination 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 management 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 Liposarcoma 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 the most common histologic 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).
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
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the spermatic cord and testis with high ligation.3 Liposarcomas 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 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 Â 12 cm in the right iliac fossa and pelvis, firm, nontender 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 echoic mass in
right iliac fossa.
CECT showed a 21 Â 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 lipomatous 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.
Fig. 2 e CECT of pelvis showing mass in iliac fossa with
minimal enhancement on contrast.
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. 3 e Mass in right lower abdomen.
Fig. 4 e Large tumor dissected through inguinal
exploration.
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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.
Fig. 5 e Histopathological pictures of well defined
liposarcoma of spermatic cord (myxoid variant).
Conclusion
Liposarcoma of the spermatic cord is rare
Surgical treatment is the management of choice with Radical orchiectomy and wide local excision
Adjuvant radiation should be given if margin status is in
doubt10
High incidence of local recurrence mandates 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.
references
Fig. 6 e Histopathological pictures of well defined
liposarcoma of spermatic cord (myxoid variant).
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
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a diagnostic dilemma. JRSM Short Rep. 2010 November;1(6):49.
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3. Coleman J, Brennan MF, Alektiar K, et al. Adult spermatic cord
sarcomas: management and results. Ann Surg Oncol.
2003;10:669e675.
4. Montgomery E, Fisher C. Paratesticular liposarcoma:
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5. Hinman F, Gibson TE. Tumor of the epididymis, spermatic
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6. Wilson N, Davis A, Bell R, Wilson AN, Davis A, Bell RS. 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.
7. Blitzer PH, Dosoretz DE, Proppe KH. Treatment of malignant
tumors of the spermatic cord: a study of 10 cases and review
of literature. J Urol. 1981;126:611e614.
8. Pisters PW, Leung DH, Woodruff J. Analysis of prognostic
factors in patients with localized soft tissue sarcomas. J Clin
Oncol. 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 management
of spermatic cord sarcoma. Cancer. 1996;77:1873.
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