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Liposarcoma of Spermatic Cord - A Rare Entity

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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.

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.

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  • 1. Liposarcoma of Spermatic Cord - A Rare Entity
  • 2. 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 Department of Urology, Apollo Hospitals, Hyderabad, India b Department 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 Â 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 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 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 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). 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 2 e8 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
  • 3. 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 Â 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 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 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 2 e8 4 83
  • 4. 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 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. 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 cord sarcomas: 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, spermatic cord and testicular tunics: a review of literature and report of three new cases. Arch Surg. 1924;8:100. 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. 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). a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 8 2 e8 484
  • 5. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/