The rarest form of Paratesticular Leiomyosarcoma – a case report

Abstract

Paratesticular tumours make up less than 5% of intra-scrotal tumours and of these, approximately 30% are malignant tumours with sarcomas accounting for the majority.Leiomyosarcoma is a malignant tumour arising from soft tissues containing smooth muscle. They are reported as comprising between 5-30% of paratesticular sarcomas.1,2 It is extremely rare that they arise from tissue other than the spermatic cord or epididymis.The authors describe such a case of paratesticular leiomyosarcoma in a 54-year-old man who presented with a six-month history of a painful testis and who subsequently underwent radical inguinal orchidectomy and high ligation. CASE REPORTA 54-year-old man presented to his doctor with a 6-month history of a painful left testis and was referred to urology. On examination the left testis was palpable anterior to the scrotum with a hard, craggy mass felt posteriorly.Scrotal ultrasound described a 5.9 mm left upper pole mass of mixed echogenicity and increased blood flow from the left testis. Tumour markers were normal.Following multidisciplinary team discussion, a repeat ultrasound was performed by a consultant radiologist with urology expertise. The results indicated a large extratesticular mass likely arising from scrotal layers of uncertain nature but soft tissue sarcoma not ruled out.Computed tomography of the thorax, abdomen, and pelvis showed no evidence of metastasis or lymphadenopathy.After a multidisciplinary team assessment, the patient was counselled for a left radical inguinal orchidectomy. Intra-operatively the tumour was intra-tunical and appeared closely adherent to the testis and spermatic cord which made for a more challenging orchidectomy but the patient made an uneventful recovery and was discharged on post-operative on day 1.Macroscopically, there was a firm, white lobulated tumour measuring 72 × 50 × 50 mm, compressing the testis which measured 40 × 10 mm.Histopathological assessment identified a malignant tumour of the paratesticular region with no connection seen to the testis, rete testis, epididymis, or spermatic cord.Morphological features included plump, spindleshaped cells arranged in fascicular, storiform, and whorled architectural patterns. The nuclei showed coarse chromatin with moderate eosinophilic cytoplasm and exhibited moderate to marked atypia with foci of moderate to severe pleomorphism with multinucleate and large pleomorphic tumour cells. Numerous