Case report: Paratesticular dedifferentiated liposarcoma with poor prognosis

Abstract

Background/AimMost paratesticular liposarcomas (PLPSs) are well-differentiated liposarcomas (WDLPSs) with favourable prognoses. As such, the rare occurrence of PLPS often leads to its misdiagnosis as a hernia or hydrocele on physical examination. Curative resection of the tumour may not be possible in cases where PLPSs have transformed into dedifferentiated liposarcomas (DDLPSs) owing to a delay in diagnosis. Herein, we describe a case of unresectable paratesticular dedifferentiated liposarcoma (PDDLPS) with poor prognosis due to delayed diagnosis.Case ReportA 57-year-old man visited our hospital with a chief complaint of a right scrotal mass, which was diagnosed as scrotal hydrocele but without treatment or follow-up. Eight years later, the patient complained of abdominal distension, and a computed tomography scan revealed the presence of retroperitoneal and right scrotal masses. The right scrotal mass was removed, and histopathology revealed DDLPS. The patient was diagnosed with unresectable PDDLPS metastasising to the retroperitoneum, and the left pleura was treated with doxorubicin. After an initial response, pleural effusion and ascites increased during the sixth cycle of chemotherapy. The patient subsequently received eribulin but died 5 months after the initial DDLPS diagnosis.ConclusionIt is difficult to distinguish PLPS from benign inguinal hernia and hydrocele testis on physical examination. PLPS generally has a considerably good prognosis. However, failure to diagnose WDLPS can be dangerous as it might lead to malignant transformation to DDLPS, which has a poor prognosis. Physicians should consider this malignancy when examining patients with hernias or hydroceles of the inguinal region and should perform ultrasonography or magnetic resonance imaging.

A Case of Mammary-Type Myofibroblastoma Occurring in the Inguinal Region

“…Ultrasonography shows a uniform hypoechoic area in the case of hydrocele testis but a heterogeneous hyperechoic area in the case of liposarcoma. In addition, MRI shows high signal intensity on T1-weighted images in the case of a fat-fitting inguinal hernia and lipoma and a low signal intensity in the case of liposarcoma [11]. When there are no typical symptoms, such as in this case, imaging studies should be performed to guide treatment decisions.…”

Well-differentiated liposarcoma of spermatic cord presenting as recurrent inguinal hernia: a case report

“…Most of these cases were patients with well-differentiated liposarcoma or myxoid subtype which likely contributes to their improved outcomes. This differs for patients with dedifferentiated paratesticular liposarcomas, for whom recurrence is higher, outcomes are poorer, and thus, the use of chemotherapy and radiation is more frequent ( 18 - 20 ).…”

Case Report: Giant paratesticular liposarcoma was resected and refused radical orchiectomy

“…The main route of metastasis for this tumour is through the inguinal canal that extends to the peritoneal cavity, and rarely through the blood and lymphatic pathways. If WDLPS is not diagnosed in time, it may transform malignantly into DDLPS with a worse prognosis ( 5 ). These tumors present as slowly growing, painless inguinal swellings that are usually misdiagnosed as inguinal hernias, hydrocele, testicular tumors, epididymitis, orchitis, tuberculosis, and lipoma ( 13 , 14 ).…”

“…Only about 272 cases have been reported worldwide (2)(3)(4)(5)(6)(7). PLS are tumors that originate in the scrotum rather than the testis, in addition to the epididymis, the spermatic cord, and the tunica vaginalis may also be involved.…”