Rare case of paratesticular solitary fibrous tumour (lipomatous hemangiopericytoma)

Abstract

A 26-year-old male presented with an asymptomatic 6-cm left paratesticular mass. Ultrasound and magnetic resonance imaging confirmed this mass as extratesticular, likely a tumour arising from the left spermatic cord. The mass demonstrated marked avid enhancement on post-contrast images, suggestive of a spermatic cord sarcoma. A left inguinal exploration was performed and gross examination of the mass revealed a well-circumscribed tumour with a discrete capsule separating it from the ipsilateral spermatic cord. The mass was resected without performing an orchiectomy and histology demonstrated a solitary fibrous tumour (lipomatous hemangiopericytoma), with minimal proliferative activity and negative margins. The occurrence of a paratesticular solitary fibrous tumour is exceedingly rare, with only a handful of case reports. We review the literature regarding this rare entity and discuss its diagnosis and management.

Lipomatous hemangiopericytoma (adipocytic variant of solitary fibrous tumor) of the parotid gland: A case report and review of the literature

“…To date, a total of 52 pathologically confirmed cases of LHPC have been reported, including that of the present patient (2–6). These patients consisted of 31 males and 21 females, ranging in age from 21 to 79 years, with average and median ages of 50.96 and 51 years, respectively.…”

“…Grossly, LHPC generally presents as a well-circumscribed, often non-encapsulated, medium-sized mass with alternating areas of white/yellow tumor tissue in the cut surface (2). Microscopically, these tumors characteristically show a varying combination of patternless cellular areas composed of round to spindle-shaped cells, hemangiopericytoma-like vascular areas made up of small- to medium-sized thin-walled branched vessles, and lipomatous areas made up of mature adipocytes (2–6). Long-term follow-up is recommended (3,5).…”

“…Long-term follow-up is recommended (3,5). To date, 51 cases of LHPC have been documented in the published literature (2–6). However, there have been no reports of parotid gland LHPC.…”

Paratesticular sarcomas: two cases with different evolutions

“…A total of 75% of paratesticular sarcomas originate from the spermatic cord 3. In total, 70% of paratesticular tumours are benign, being lipomas; adenomatoid tumours and leiomiomas are the most common histological types 4. Only 30% of paratesticular tumours are malignant and 90% of them are sarcomas 5.…”

“…The most aggressive histological subtype is rhabdomyosarcoma, predominating in the first two decades of life; more differentiated tumours such as liposarcoma, leiomyosarcoma and fibrosarcoma are more frequently in adults 3 4…”