JCCO
Journal of Cancer and Clinical Oncology Vol. 1(1), pp. 005-007, July, 2014. © www.premierpublishers.org. ISSN: 5907-4449
x
Editorial Case report
Liposarcoma paratesticular region: A rare case report 1
Hakim Irfan Showkat*, 2Gul Mohammad Bhat, 3Mohmad Hussain Mir, 4Sheikh Ajaz Aziz, 5Arif Hussain Sarmast and 6Basharat Mujtaba 1,2,3,4,5,6
Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
Liposarcomas of the paratesticular region are rare tumors that usually present as painless, slowly growing inguinal or scrotal masses.They are usually diagnosed as being an inguinal hernia or lipoma before surgical intervention. Paratesticular liposarcomas are rare tumors and are usually seen in patients in middle age or elderly. We report a case of paratesticular liposarcoma who presented with a gradually progressive inguinal region swelling. Keywords: Liposarcoma, tumour, hernia, paratesticular, swelling INTRODUCTION Paratesticular liposarcomas are rare and typically reported as an isolated case or components of larger studies of liposarcomas. Paratesticular well-differentiated liposarcoma has a prolonged clinical course with recurrences in more than half the cases, sometimes late. There are no metastases and the overall prognosis is good (Wilson et al, 1994). Most paratesticular malignant tumors are usually sarcomas. Paratesticular liposarcoma most commonly originates in the spermatic cord. CASE HISTORY A 60 year-old male presented with a progressive, painless swelling in the left inguinoscrotal region from last 9 months.Systemic examination was normal. Local examination revealed a left inguinoscrotal swelling 10 x 8 cm, with penis pushed to opposite side. Cough impulse was negative. On palpation a firm, smooth-surfaced mild tender swelling was felt and testis was separate from the swelling. The swelling was irreducible with no fluctuation. The transillumination test was negative. There was no associated inguinal lymphadenopathy. Ultrasonography (USG) reported this mass to be inhomogeneous and hyperechogenic, 9.8 x 7 x 6.3 cm (Fig 1) and separate from the testis and epididymis as well and Doppler showing normal vasculature. Contrast enhanced
computed tomography (CECT) pelvis and abdomen gave an impression of sarcoma in the paratesticular region with no lymphnode involvement (Fig 2). Surgical exploration was done with wide excision of the mass and orchidectomy and the section sent for histopathology which revealed liposarcoma (Fig 3). Immunohistochemistry showed S-100 Protein positive and negative for SMA, Desmin, H-Caldesmin and myogenin. Other markers like alpha fetoprotein, HCG (human chorionic gonadotrophin), lactate Dehydrogenase (LDH), PSA (prostate specific antigen) were normal. The patient recieved chemotherapy (Adriamycin and Ifosfamide) and is on our regular follow up from past 8 months without any complaints. He is planned to be followed for a long time for any probable relapse.
*Corresponding author: Dr. Hakim Irfan Showkat, Senior Resident, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India, Editor-in-chief JCCO, E-mail:
[email protected], Tel: +919419028326
Liposarcoma paratesticular region: A rare case report
Showkat et al
005
Figure 1: Ultrasonography (USG) reported this mass to be inhomogeneous & hyperechogenic
Figure 2: CECT: sarcoma in the paratesticular region with no lymphnode involvement
DISCUSSION Paratesticular liposarcomas are rare tumors and are . often reported as isolated cases (Montgomery, 2003) Paratesticular liposarcoma is extremely rare and only 41 cases have been reported in the literature (Littles, 1992). They refer to liposarcomas arising from the spermatic cord, testicular tunics and epididymes, and usually occur
in men aged 41 years to 87 years (Montgomery, 2003). Myxoid liposarcomas account for 40-50% of all liposarcomas and the survival depends both on the histological appearance as well as their anatomical location (Gerber 1985; Mostafi 1973). This tumor is difficult to diagnose preoperatively and is often mistaken for incarcerated hernia, lipoma, or hydrocele. Liposarcomas in general have been classified into
Liposarcoma paratesticular region: A rare case report
J. Cancer Clin. Oncol.
006
Figure 3: Histopathgology examination (low power/high power) revealed liposarcoma Immunohistochemistry showed S-100 Protein positive and negative for SMA, Desmin , H-Caldesmin and myogenin.
myxoid (most common; 40%), round cell, well differentiated (subdivided into lipoma-like, sclerosing, inflammatory and dedifferentiated), and pleomorphic) (Logan, 2010). The low grade, well-differentiated and myxoidliposarcomas have favourable prognosis, whereas tumors with multiple recurrences or metastases are likely to be of the high grade, round cell, pleomorphic, or mixed variety. Complete surgical resection offers the best chance of cure for these patients (Mondaini, 2004) and the established method for orchidectomy for testes/cord cancer is through an inguinal incision (Rowland, 2002). Liposarcomas are locally aggressive tumors and recurrence is quite common after incomplete excision. The inguinal radical orchidectomy with wide resection margin is the standard approach for sarcomas of the spermatic cord (Mondaini, 2004). When local recurrence has occurred, neoadjuvant chemotherapy with complete tumor excision is a useful method of achieving local control. Due to the rarity of the disease there is no definite universal consensus of opinion as regards the role of radiotherapy and chemotherapy (Haider, 2013) Late recurrences in these patients may occur and a long follow up of these patients is mandatory (Wilson, 1994). REFERENCES Wilson AN, Davis A, Bell RS, O'Sullivan B, Catton C, Madadi F, Kandel R, Fornasier VL (1994). Local
control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy. Eur. J. Cancer, 30(6): 746–751. Haider A, Elsawi MO, Mohamed AG (2013). Paratesticular Liposarcoma: A Case Report and Review of the Literature,” Case Reports in Urology, 2013: 806289. PMID 23533935 Gerber WL (1985) Scrotal malignancies: The University of Iowa experience and a review of the literature. Urology, 26: 337-342. Logan JE, Williams MB, Shaves ME, McCammon KA (2010). Liposarcoma of the spermatic cord: a case report and review of management, UroTod. Int. J., 3(4). Littles JF, Matter RC, Herman G (1992) Paratesticular liposarcoma: A report of two cases and review of the literature. J Natl Med Assoc. 1992 November; 84(11): 951–955. Montgomery E, Fisher C (1973). Paratesticular liposarcoma: a clinicopathologic study. Am. J. Surg. Pathol. 2003; 27:20-47. Mostofi FK, Price EB (1973). Tumors of fatty tissue. In, "Tumors of the Male General System." Atlas of Tumor Pathology, second series, Fascicle 8, Editor: H. I. Firminger. Armed Forces Institute of Pathology, Washington D.C., 166-167. Mondaini N, Palli D, Saieva C, Nesi G, Franchi A, Ponchietti R, Tripodi S, Miracco C, Meliani E, Carini M, Livi L, Zanna I, Trovarelli S,Marino V, Vignolini G,
Liposarcoma paratesticular region: A rare case report
Showkat et al
007
Pomara G, Orlando V, Giubilei G, Selli C, Rizzo M (2004) Clinical characteristics and overall survival in adult genitourinary sarcomas treated with a curative intent: a multicenter study. Eur Urol., 47:468-73. Rowland RG, Herman JR (2002). Tumors and infectious diseases of the testes. In: Gillenwater JY, Grayhack JT, Howard SS, Mitchell ME, editors. Adult and pediatric urology, 4th ed. Philadelphia: Lippincott Williams and Wilkins. Accepted 7 July, 2014.
Citation: Showkat HI, Bhat GM, Mohmad HM, Sheikh AA, Arif HS, Mujtaba B (2014). Liposarcoma paratesticular region: A rare case report. Journal of Cancer and Clinical Oncology 1(1): 005-007.
Copyright: © 2014 Showkat et al. This is an openaccess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.
Liposarcoma paratesticular region: A rare case report
