A Rare Case of Paratesticular Leiomyosarcoma

Abstract

Soft-tissue sarcomas of the genitourinary tract account for only 1–2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

A rare case of paratesticular leiomyosarcoma

“…Sarcomas of the genitourinary tract are uncommon and represent only 1–2% of all urological malignancies [ 1 ]. Less common are sarcomas of the paratesticular region, comprising tissues such as the epididymis, spermatic cord, inguinal canal and testicular tunica [ 1 ]. Localization to the epididymis is extremely rare (accounting for 4% of all paratesticular sarcomas).…”

“…Paratesticular sarcomas are rare, with only 110 cases reported in literature [ 1 ]. The most common histological subtypes include liposarcoma, leiomyosarcoma (LMS) and rhabdomyosarcoma.…”

Paratesticular Leiomyosarcoma: A Case Report and Review of the Literature

“…Paratesticular LMS originates from the spermatic cord, the scrotum (testicular tunica, dartos muscle and scrotal subcutis) or the epididymis. The most common type arises from undifferentiated mesenchymal cells of the cremasteric muscle and vas deferens 1, 4. The epididymal form is less frequent and arises from the smooth muscle surrounding the basement membrane of the epididymis canal 4 .…”

“…The first two aforementioned types drain into the retroperitoneal lymph nodes in contrast with the last type, which drains into the inguinal, external and internal iliac nodes. The most common mode of spread is lymphatic, followed by hematogenous and by local extension to scrotum, inguinal canal or pelvis 1 . Hematogenous metastases are primarily pulmonary or hepatic.…”

“…Soft tissue sarcomas of the genitourinary tract account for less than 5% of all sarcomas and only 2% of urological malignancies 1 . Paratesticular tumors, which include those arising from testicular tunics, epididymis and spermatic cord are rare and their incidence is difficult to estimate 2 .…”