Paratesticular liposarcoma of the spermatic cord: A rare case

Abstract

Sushma Shankar, Bhaskaran Ashokan, Muni Reddy,Hemalatha Anantharamaiah

Spermatic cord liposarcomas (LPS) are rare representing 7% of paratesticular sarcomas. The most present as slow growing inguinal or scrotal masses that need to be differentiated from inguinal hernias, testicular tumors, hydrocele, and benign lipomas. A 57-year-old male presented with right scrotal swelling since 1 year that grew rapidly in last 4 months. On examination, a firm, nontender mass was felt in the right scrotum measuring 12 cm × 8 cm. A clinical diagnosis of right testicular tumor was made. Ultrasound scrotum– large, heteroechoeic mass separate from right testis. Magnetic resonance imaging scrotum well-defined, homogenously enhancing extra testicular mass with fat component? Paratesticular lipoma/liposarcoma. Right radical orchiectomy, high ligation of spermatic cord, and excision of mass en bloc were performed. Gross findings: Multiple, globular, gray yellow, firm masses seen in the paratesticular area and spermatic cord, the largest measuring 11 cm × 7 cm × 5 cm. Testis, epididymis-normal. Cut surface–solid, yellowish white with myxoid areas. Microscopy-mature adipocytes of varying sizes separated by dense fibrillary fibrocollagenous stroma with pleomorphic, bizarre stromal cells, and multinucleate giant cells. Interspersed areas showed extensive mast cell infiltration and myxoid change. Diagnosis, well-differentiated liposarcoma/ atypical lipomatous tumor sclerosing type of paratesticular area (spermatic cord). Paratesticular LPS of spermatic cord are rare tumors often misdiagnosed clinically resulting in incomplete excision and high recurrences. This report highlights the need of considering liposarcoma as a differential diagnosis in inguinoscrotal masses and stresses the role of histopathological examination in making a definitive diagnosis, which cannot be established clinically/radiologically.