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Huayanay Espinoza JL, Espinoza Figueroa JVJ, Velezmoro Díaz VE, Huanca Amesquita LS, Cruz Baca RC, Rioja Vega MA, Guelfguat M. Soft-Tissue Sarcomas of the Genitourinary Tract with Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230138. [PMID: 38236750 DOI: 10.1148/rg.230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Genitourinary tract soft-tissue sarcomas are rare neoplasms with varied pathologic and clinical features. While some of these tumors may be aggressive high-grade malignancies, others are low grade with a relatively better prognosis. Given that the grade and extent of the disease are important prognostic factors in these tumors, timely diagnosis is crucial. Unfortunately, most imaging features of these malignancies are not pathognomonic, and various histologic subtypes do not manifest with typical classic imaging features. Therefore, reliable differentiation of the various histologic tumor types is not always possible based solely on the radiologic manifestations. Imaging findings need to be considered in the context of clinical history in corroboration with radiologic-pathologic correlation. The authors discuss the specific imaging and pathologic characteristics of various genitourinary tract soft-tissue sarcomas, emphasizing diagnostic difficulties and differential diagnoses. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jorge L Huayanay Espinoza
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Jossue V J Espinoza Figueroa
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Vanessa E Velezmoro Díaz
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Lourdes S Huanca Amesquita
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Renier C Cruz Baca
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Marco A Rioja Vega
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Mark Guelfguat
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
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Azizi MH, Rizuana IH, Wong YP, Sidek K, Fam XI. Giant paratesticular dedifferentiated liposarcoma with intraabdominal extension: a case report. Front Oncol 2023; 13:1216776. [PMID: 37564941 PMCID: PMC10410441 DOI: 10.3389/fonc.2023.1216776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Giant paratesticular liposarcoma is a rare presentation of paratesticular tumor. We present a case of the largest paratesticular liposarcoma described to date with a weight of 4,100 g and measuring 460 × 210 × 130 mm. It was initially mistaken as an inguinoscrotal hernia until a contrast-enhanced computed tomography (CECT) scan of the abdomen and pelvis revealed a huge left paratesticular tumor extending from the scrotum to the mid-abdomen. The challenge was to achieve a tumor-free margin orchidectomy due to the poor fat plane of the tumor to the external iliac artery, psoas muscle, descending colon, and anterior abdominal wall. The surgery was started with laparoscopic dissection for the intraabdominal part of tumor from the vital structure, then followed by inguinal radical orchidectomy and inguinal mesh repair. Postoperative histopathological report revealed a paratesticular dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation with clear margin. The patient had good recovery post operation.
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Affiliation(s)
- Muhammad Hasif Azizi
- Urology Unit, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Iqbal Hussain Rizuana
- Department of Radiology, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Khairiyah Sidek
- Department of Oncology, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Xeng Inn Fam
- Urology Unit, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Achard G, Charon-Barra C, Carrere S, Bonvalot S, Meeus P, Fau M, Honoré C, Delhorme JB, Tzanis D, Le Loarer F, Karanian-Philippe M, Ngo C, Le Guellec S, Bertaut A, Causeret S, Isambert N. Prognostic factors and outcomes of adult spermatic cord sarcoma. A study from the French Sarcoma Group. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1203-1208. [PMID: 36868941 DOI: 10.1016/j.ejso.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS). METHODS All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS). RESULTS A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1-2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3-90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6-74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR. CONCLUSIONS Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront.
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Affiliation(s)
- Gilles Achard
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Céline Charon-Barra
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sebastien Carrere
- Department of Surgery, Institut du Cancer de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France.
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Magali Fau
- Department of Surgery, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Jean-Baptiste Delhorme
- Department of Surgery, Centre Hospitalier Universitaire hautepierre, 1 Avenue Moliere, 67000, Strasbourg, France
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Marie Karanian-Philippe
- Department of Pathology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Carine Ngo
- Department of Pathology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Sophie Le Guellec
- Department of Pathology, Institut Universitaire de Cancer de Toulouse Oncopole, avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Aurélie Bertaut
- Department of Biostatistics, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
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Aksoy C, Karschuck P, Derigs M, Sevinc S, Groeben C, Zacharis A, Flegar L, Pehl A, Huber J, Mandal S. Successful management of 30 kg Gigantic para-testicular liposarcoma. BMC Urol 2023; 23:92. [PMID: 37170356 PMCID: PMC10176928 DOI: 10.1186/s12894-023-01236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular "giant" mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising.
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Affiliation(s)
- Cem Aksoy
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany.
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Marcus Derigs
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Selim Sevinc
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Aristeidis Zacharis
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Anika Pehl
- Department of Pathology, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Subhajit Mandal
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
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Liu Y, Zhang Z, Wang J, Wang S. Effects of radiotherapy on the survival of patients with malignant spermatic cord tumors: A retrospective cohort study. Cancer Med 2023; 12:5580-5589. [PMID: 36354142 PMCID: PMC10028065 DOI: 10.1002/cam4.5402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Malignant spermatic cord tumors (SCT) are rare and currently, there is no consensus regarding the role of radiotherapy in their treatment. This study evaluated the effect of radiotherapy on the overall survival (OS) of patients with malignant SCT based on the large-sample advantage of the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with malignant SCT recorded in the SEER database from 1975 to 2016 were included. All patients were divided into non-radiation and radiation groups, and propensity score matching (PSM) (1:1) was performed for baseline covariates between the two groups. The overall survival rate between the two groups of patients was analyzed using the Kaplan-Meier curve. The effects of radiotherapy on patient prognosis were analyzed using univariate and multivariate COX regression analyses. RESULTS In total, 389 patients with malignant SCT were included. There were 285 (73.26%) and 104 (26.74%) patients who either did or did not receive radiotherapy, respectively. Kaplan-Meier curves before and after PSM showed no significant differences in OS between the two groups. Similarly, multivariate COX regression models before and after PSM showed that radiotherapy was not an independent risk factor for OS in patients with malignant SCT. CONCLUSIONS Radiotherapy has no obvious advantage in improving the survival time of patients with malignant SCT.
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Affiliation(s)
- Yifu Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhicheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinxiang Wang
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Siyuan Wang
- Department of Urology, Sichuan Cancer Hospital, Chengdu, China
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Song R, Xi J, Shi H, Xue Z, Li H, Yu X. Ultrasonographic manifestations and the effective diagnosis of epididymal leiomyosarcoma: Case report and systematic literature review. Front Oncol 2023; 13:1101801. [PMID: 36845710 PMCID: PMC9950396 DOI: 10.3389/fonc.2023.1101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background Epididymal leiomyosarcoma is an extremely rare tumor. In this study, we describe the sonographic features of this uncommon tumor. Methods A case of epididymal leiomyosarcoma diagnosed at our institute was retrospectively analyzed. Ultrasonic images, noted clinical manifestations, treatment procedures, and pathology results were collected for this patient. The same information was collected from a systematic literature search on epididymal leiomyosarcoma, including the PUBMED, Web of Science and Google Scholar databases. Results The literature search resulted in 12 articles; we were able to extract data from 13 cases of epididymal leiomyosarcomatosis. The median patient age was 66 (35-78) years, and the average tumor diameter was 2-7 cm. All patients had unilateral epididymal involvement. The lesions were all solid, irregular-shaped in almost half of the cases, featured clear borders in six cases, and had unclear borders in four cases. The internal echogenicity was heterogeneous in the majority of lesions: six cases were hypoechoic (7/11) and three cases moderately echoic (3/10). Information on blood flow within the mass was provided in four cases, but all were noted with significant vascularity. Surrounding tissue invasion was discussed in 11 cases, with 4 featuring peripheral invasion or metastasis. Conclusion Epididymal Leiomyosarcoma demonstrates sonographic characteristics common to many malignant tumors, such as increased density, irregular shape, heterogeneous internal echogenicity, and hypervascular. Ultrasonography is helpful to differentiate benign epididymal lesions, and can provide some reference for clinical diagnosis and treatment. However, compared with other malignant tumors of the epididymis, it has no characteristic sonographic features,and pathological confirmation is required.
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Affiliation(s)
- Ruixiao Song
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Jing Xi
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Zhixin Xue
- Department of Pathology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Huifang Li
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaolong Yu
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China,*Correspondence: Xiaolong Yu,
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Huang LC, Ke CC, Wang CC. Spermatic cord dedifferentiated liposarcoma: A lethal disease disguises as a mundane mishap. Asian J Surg 2023:S1015-9584(23)00120-3. [PMID: 36732192 DOI: 10.1016/j.asjsur.2023.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Liang-Chen Huang
- Division of Urology, Department of Surgery, En Chu Kong Hospital, New Taipei City, 237, Taiwan
| | - Chih-Chun Ke
- Division of Urology, Department of Surgery, En Chu Kong Hospital, New Taipei City, 237, Taiwan; PhD Program in Nutrition & Food Science, Fu Jen Catholic University, New Taipei City, 242, Taiwan.
| | - Chung-Cheng Wang
- Division of Urology, Department of Surgery, En Chu Kong Hospital, New Taipei City, 237, Taiwan; Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan City, 320, Taiwan.
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Hua R, Zhao L, Xu L, Sun J, Huang J, Hua Q. Recurrent paratesticular giant liposarcoma: A case report and literature review. Front Surg 2023; 10:1171952. [PMID: 37181598 PMCID: PMC10172677 DOI: 10.3389/fsurg.2023.1171952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary paratesticular liposarcoma is rarely diagnosed among urinary tumors. In this study, through the retrospective analysis of clinical data and literature review, a case of recurrent paratesticular liposarcoma with lymph node metastasis after radical resection has been reported to explore novel strategies for the diagnosis, treatment and prognosis of this rare disease. Case summary The present case involved a patient who was misdiagnosed as a left inguinal hernia for the first time two years ago, but was later diagnosed as mixed liposarcoma by using postoperative pathology. Currently, he is readmitted to the hospital with a recurrence of the left scrotal mass for more than 1 year. Combined with the patient's past medical history, we performed radical resection of the left inguinal and scrotal tumors and lymphadenectomy of left femoral vein. The postoperative pathology indicated that well-differentiated liposarcoma was accompanied by mucinous liposarcoma (about 20%), and lymph node metastasis of left femoral vein both of which occurred at the same time. After the operation, we recommended the patient to receive further radiation therapy, but the patient and his family refused, hence we followed up the patient closely for a long time. During the recent follow-up, the patient reported no complaints of discomfort, and no recurrence of mass in the left scrotum and groin area. Conclusion After conducting extensive review of literature, we conclude that radical resection remains the key to treat primary paratesticular liposarcoma, while the significance of the lymph node metastasis is still unclear. The potential effects of postoperative adjuvant therapy depends on the pathological type, and hence close follow-up observation is essential.
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Affiliation(s)
- Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Li Xu
- Department of Urology, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Qiyan Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
- Correspondence: Qiyan Hua
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Suto H, Inui Y, Okamura A. Case report: Paratesticular dedifferentiated liposarcoma with poor prognosis. Front Oncol 2022; 12:1085794. [PMID: 36531026 PMCID: PMC9754323 DOI: 10.3389/fonc.2022.1085794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND/AIM Most 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 REPORT A 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. CONCLUSION It 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.
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Affiliation(s)
- Hirotaka Suto
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Medical Oncology/Haematology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Yumiko Inui
- Department of Medical Oncology/Haematology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Atsuo Okamura
- Department of Medical Oncology/Haematology, Kakogawa Central City Hospital, Hyogo, Japan
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Chan K, Odubanjo T, Swamy R, Hosny M. Giant Paratesticular Liposarcoma Mimicking a Left-Sided Groin Hernia: A Case Report. Cureus 2022; 14:e28856. [PMID: 36225510 PMCID: PMC9536849 DOI: 10.7759/cureus.28856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Giant paratesticular liposarcoma (PLS) is an uncommon tumour, often misdiagnosed pre-operatively, which presents as a painless scrotal mass. Early detection and prompt surgical management provide the best outcome. We present an 87-year-old patient with gradually enlarging, painless left scrotal swelling. Ultrasound on initial presentation suggested a benign hernia, resulting in an 11-month treatment delay. Computed tomography (CT) thereafter showed paratesticular scrotal mass measuring 14 x 8 x 7cm. Radical inguinal orchidectomy with high ligation of the spermatic cord was performed. Histopathology and cytogenetics confirmed PLS with both de-differentiated and well-differentiated features involving the spermatic cord margin. The patient had rapid progression to fatal lung metastasis within three months of surgery. Our case highlights that any suspicious fat swelling should be investigated thoroughly and excised promptly if paratesticular liposarcoma is suspected, as delayed management gives poor outcomes.
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Marzocchi G, Gentilini M, Cavini M, Lovato L. CT imaging of an unusual malignant inguinal mass: metastatic parafunicular dedifferentiated liposarcoma. BMJ Case Rep 2022; 15:e248332. [PMID: 35580951 PMCID: PMC9115031 DOI: 10.1136/bcr-2021-248332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 01/09/2023] Open
Abstract
A man in his 50s was redirected by his general practitioner to our University Hospital for a radiological evaluation after the complaint of a left inguinal swelling. The preliminary ultrasound and CT scan showed a left parafunicolar mass located between the root of the penis and the spermatic cord. The lesion was biopsied shortly after and histologically diagnosed as a dedifferentiated liposarcoma. The patient underwent a cycle of neoadjuvant radiotherapy, which proved to be ineffective. He was then subjected to an organ sparing surgical removal of the mass, followed by a second organ sparing removal of some residual disease. The last CT scan showed absence of the inguinal disease; however, lung and hepatic metastasis were detected, which are scheduled to be treated with a course of chemotherapy and radiofrequency.
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Affiliation(s)
- Guido Marzocchi
- Emergency Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Mattia Gentilini
- Department of Radiology, Ospedale Maurizio Bufalini, Bologna, Italy
| | - Marco Cavini
- Emergency Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
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12
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Karbasian N, Segaran N, Solomon N, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Pathologic Conditions at Imaging of the Spermatic Cord. Radiographics 2022; 42:741-758. [PMID: 35394888 DOI: 10.1148/rg.210161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Niloofar Karbasian
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
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13
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Ozer M, Juneja K, Mahdi M, Jannareddy N, Gandhi N. Unilateral Proptosis due to Orbital Metastasis of Paratesticular Leiomyosarcoma. Eur J Case Rep Intern Med 2021; 8:002315. [PMID: 33869092 DOI: 10.12890/2021_002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 11/05/2022] Open
Abstract
Paratesticular leiomyosarcomas are uncommon malignant tumours that originate from smooth muscle and show aggressive tumour behaviour due to a high incidence of local recurrence and distant metastasis. Orbital metastasis is also rare and associated with a poor prognosis. Clinical suspicion plays an essential role in the diagnosis of orbital leiomyosarcoma because of its uncommon presentation. Comprehensive neuroimaging and histopathological work-up are warranted for definitive diagnosis and management. To date, surgical resection remains the best curative treatment. However, leiomyosarcomas are usually friable and unencapsulated, which makes surgery challenging. Also, whether adjunctive chemotherapy will alter the long-term prognosis remains to be determined. Herein, we report the case of a middle-aged man who presented with proptosis and decreased vision, who was subsequently diagnosed with metastatic orbital leiomyosarcoma from a primary paratesticular tumour. We performed orbital enucleation with negative margins. The patient is currently under systemic pazopanib chemotherapy. LEARNING POINTS Orbital metastasis from paratesticular leiomyosarcoma is rarely encountered and shows aggressive behaviour.Clinical suspicion plays an essential role in diagnosing orbital leiomyosarcoma as this is an uncommon and atypical cause of proptosis and can be easily misdiagnosed by physicians.Curative surgical treatment should be considered due to the high recurrence rate.
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Affiliation(s)
- Muhammet Ozer
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Kirti Juneja
- Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Mohammed Mahdi
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Namrata Jannareddy
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Neel Gandhi
- Department of Hematology and Oncology, Capital Health Regional Medical Center, Trenton, NJ, USA
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Technical illustration of Volumetric arc conformal radiotherapy planning in a case of paratesticular sarcoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Introduction:
Paratesticular sarcoma are extremely rare malignant tumours. Unlike other sites, they tend to be lower grade and have higher propensity of lymphatic spread. They tend to fail locally and occasionally in the regional lymph nodes. In the absence of target volume delineation guidelines and technical illustration of conformal planning, we have made an attempt to illustrate conformal planning methodology and define target volume based on current evidence in a case of paratesticular sarcoma.
Methods:
We are presenting a case of 62-year-old male who presented with 15-cm scrotal swelling and underwent high inguinal orchidectomy with ligation of spermatic cord. Histopathology presented a well-differentiated leiomyosarcoma of epididymis. Post-operative radiotherapy target volume included the tumour bed, ipsilateral inguinal nodes and lower pelvic nodes as the clinical target volume.
Conclusion:
Adjuvant radiotherapy using advanced delivery technique such as volumetric arc technique can provide good dose distribution with good sparing of organs at risk. The downside of conformal radiation delivery is that it is a resource-intensive and has no established target volume delineation guidelines.
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15
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Dunev VR, Genov PP, Georgiev MI, Stoykov BA, Kolev NH. A rare case of liposarcoma of the spermatic cord. Urol Case Rep 2020; 33:101336. [PMID: 33102038 PMCID: PMC7573950 DOI: 10.1016/j.eucr.2020.101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/03/2020] [Indexed: 12/04/2022] Open
Abstract
We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.
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Affiliation(s)
- V R Dunev
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
| | - P P Genov
- Medical University Pleven, 8A "Georgi Kochev" Str. 5800, Bulgaria
| | - M I Georgiev
- Medical University Sofia, 1 "Georgi Sofiiski" Str. 1431, Bulgaria
| | - B A Stoykov
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
| | - N H Kolev
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
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16
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Liposarcoma of the spermatic cord presenting as an inguinal hernia. Int J Surg Case Rep 2020; 76:274-277. [PMID: 33059204 PMCID: PMC7566205 DOI: 10.1016/j.ijscr.2020.09.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Dedifferentiated liposarcoma is a rare, highly malignant, rapidly recurring tumor. When found in the spermatic cord, this tumor may deceptively present as an inguinal hernia, and due to its rarity, may not be readily identified. PRESENTATION OF CASE We report a case of a 46-year old man with dedifferentiated liposarcoma presenting as a slow-growing right inguinal bulge. His surgical management included ipsilateral orchiectomy and excision with wide margins. He received adjuvant focused radiation therapy. CONCLUSION Liposarcoma of the Spermatic Cord is a rare and highly malignant tumor that rapidly recurs. Therefore, a high degree of suspicion, regular surveillance and imaging are justified.
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17
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Salas-Parra RD, Tavares LL, Gupta R, Silletti J, Shah A. Dedifferentiated liposarcoma of the scrotum. Case report and literature review. J Surg Case Rep 2020; 2020:rjaa342. [PMID: 32968479 PMCID: PMC7497061 DOI: 10.1093/jscr/rjaa342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/14/2022] Open
Abstract
Malignant paratesticular and spermatic cord tumors are rare and often misdiagnosed preoperatively due to clinical presentations similar to other benign scrotal mass etiologies. Only a few cases regarding giant, paratesticular liposarcomas (>10 cm) have been reported. We report a unique case of an aggressive giant dedifferentiated liposarcoma of the scrotum with osteosarcoma features in a 70-year-old patient who initially presented with indolent scrotal swelling. A CT scan showed a large, complex, solid and cystic mass (12.0 x 15.5 x 19.0 cm) in the right scrotum. With a concern of a complex hydrocele, the patient was taken to the operating room for a scrotal approach to excise the hydrocele, but the spermatic cord was not traced to any discernible testicle as the entire mass was indurated and multilocular, and was excised. Pathology revealed a dedifferentiated liposarcoma, with MDM2 amplification. The patient’s course was complicated due to metastatic disease.
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Affiliation(s)
- Ruben D Salas-Parra
- Department of Surgery, Bronxcare Health System, Bronx, NY 10457, United States
| | | | - Ranjan Gupta
- Department of Surgery, Bronxcare Health System, Bronx, NY 10457, United States
| | - Joseph Silletti
- Department of Surgery, Division of Urology, Bronxcare Health System. Bronx, NY 10457, United States
| | - Ajay Shah
- Department of Surgery, Bronxcare Health System, Bronx, NY 10457, United States
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18
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Optimal treatment strategy for paratesticular liposarcoma: retrospective analysis of 265 reported cases. Int J Clin Oncol 2020; 25:2099-2106. [PMID: 32715355 DOI: 10.1007/s10147-020-01753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Liposarcoma is one of the most common subtypes of soft tissue sarcoma. Although the standard treatment for localized liposarcoma is surgical resection with negative margins, a treatment specific to paratesticular liposarcoma has yet to be quantitatively evaluated. METHODS A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular liposarcoma published between 1979 and 2018 in English. The final cohort included 265 patients in 183 articles. The starting point was the time of surgical treatment, and the endpoint was the time of recurrence, including local recurrence, or distant metastasis. RESULTS The median patient age was 62 years and the median tumor size was 9.5 cm. In total, 178 patients underwent high inguinal orchiectomy and 40 underwent simple tumorectomy. Based on the Kaplan-Meier curves, recurrence-free survival rates were significantly higher for those who underwent high inguinal orchiectomy than for those who underwent tumorectomy. Moreover, those with microscopic positive margins had a higher risk of recurrence than those with negative margins, but adjuvant radiation therapy after resection had no statistically significant effect on recurrence-free survival, even in subgroup analysis of patients with positive margins. Regarding the pathological subtypes, dedifferentiated, pleomorphic, and round-cell liposarcoma had a higher risk of recurrence than well-differentiated or myxoid liposarcoma. In the multivariate analysis, high inguinal orchiectomy greatly affected recurrence-free survival. The tumor size and histological subtype were independent risk factors for recurrence. CONCLUSION Complete resection with high inguinal orchiectomy is the optimal treatment for paratesticular liposarcoma.
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Noguchi T, Fukushima T, Hara H, Sekiguchi N, Kobayashi T, Ozawa T, Gomi D, Koizumi T. Giant paratesticular liposarcoma with lung metastases: a case report and review of the literature. J Med Case Rep 2020; 14:86. [PMID: 32611426 PMCID: PMC7330966 DOI: 10.1186/s13256-020-02420-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 05/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Due to its rarity, little is known about the clinical presentations and responses to systemic chemotherapies in advanced and/or metastatic cases of paratesticular liposarcoma. CASE PRESENTATION Here, we report the case of a 75-year-old Japanese man with giant paratesticular liposarcoma. Imaging studies revealed a 26 cm tumor in his right scrotum and lung metastases at presentation. He underwent radical orchiectomy followed by systemic chemotherapies. Pathological findings of the resected primary tumor confirmed a dedifferentiated liposarcoma. He then started chemotherapy treatment with gemcitabine plus docetaxel. His disease status was stable for 1 year. Eribulin was used for second-line chemotherapy. He had a relapse at 5 months after eliburin and died at 22 months after diagnosis. CONCLUSION Early diagnosis and curative radical surgery are important for treatment of paratesticular liposarcoma. However, a giant paratesticular liposarcoma could cause metastases, and systemic chemotherapy may be helpful for prolonging survival in patients with metastatic paratesticular liposarcoma.
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Affiliation(s)
- Takuro Noguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hiroaki Hara
- Department of Urology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takesumi Ozawa
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Daisuke Gomi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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20
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Chen X, Zou C, Yang C, Gao L, Bi LK, Xie DD, Yu DX. Pleomorphic rhabdomyosarcoma of the spermatic cord and a secondary hydrocele testis: A case report. World J Clin Cases 2020; 8:2641-2646. [PMID: 32607344 PMCID: PMC7322420 DOI: 10.12998/wjcc.v8.i12.2641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pleomorphic rhabdomyosarcoma (RMS) of the spermatic cord is a group of rare neoplasms, and a secondary hydrocele testis occasionally occurs. The misdiagnosis of paratesticular mass may lead to a therapeutic delay.
CASE SUMMARY A 79-year-old man presented to our clinic complaining of a 1-mo history of painless scrotal swelling. Physical examination revealed approximately a 15 cm × 10 cm × 5 cm inguinal mass with limited mobility. Contrast-enhanced magnetic resonance imaging showed a hydrocele testis, several enlarged inguinal lymph nodes, and a heterogeneously enhanced lesion with a relatively well-defined margin in the left inguinal region. Due to the imaging findings, he was diagnosed with pleomorphic RMS and received a wide resection of the mass, an inguinal incision with a high section of the left spermatic cord, and a left radical orchiectomy. He experienced local relapse 1 mo postoperatively and received radiotherapy and anlotinib hydrochloride-based immunotherapy as adjuvant therapy. The patient died 3 mo after the surgery.
CONCLUSION The optimal interventions for advanced-stage pleomorphic RMS patients should be investigated by more preclinical studies and clinical trials. Physicians need to be aware of the occurrence of pleomorphic RMS in unusual locations, especially when accompanied by a hydrocele testis.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Ci Zou
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Chao Yang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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21
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Shaban Y, Elkbuli A, Kim D, Abdulla A, Boneva D, McKenney M, Wolf J. Dedifferentiated liposarcoma of the spermatic cord: Case report and review of literature. Int J Surg Case Rep 2020; 72:418-422. [PMID: 32563833 PMCID: PMC7306526 DOI: 10.1016/j.ijscr.2020.06.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022] Open
Abstract
Liposarcomas typically presents as bulky heterogeneous solid lesions that are larger/firmer than simple “cord lipoma.” Tumors range from 3 to 30 cm in diameter. Current controversy in management of liposarcomas pertains to the use of adjuvant chemotherapy or radiotherapy and whether these treatment options decrease recurrence/survival. We recommend an initial complete resection with wide margins without the use of adjuvant therapy with aggressive long-term surveillance. Based on extrapolated data from studies pertaining to sarcomas of the extremities, adjuvant radiation or chemotherapy may serve a role but further research is crucial.
Introduction Malignant spermatic cord tumors have an annual incidence of 0.3 cases/million. The vast majority of tumors in this region are benign. We present a rare case of a dedifferentiated liposarcoma of the spermatic cord successfully treated. Presentation of case A 59-year-old gentleman presented complaining of an enlarging painful right groin mass. On exam there was an obvious 10 cm inguinal mass. Imaging illustrated a right inguinal soft tissue mass that was not present on imaging 22 months prior. The patient underwent a right inguinal exploration, en bloc resection of the mass, and radical orchiectomy to ensure negative margins. Histopathological analysis revealed a grade 2 dedifferentiated liposarcoma that measured 9 × 6 × 5 cm, with 5 cm negative margins. The patient did well and was discharged on postoperative day one. On 6-month follow-up there was no evidence of recurrence. Discussion We present a rare dedifferentiated liposarcoma of the spermatic cord that was successfully treated with surgical resection. This case highlights the importance of maintaining a high index of suspicion coupled with a thorough history and physical examination when encountering an enlarging inguinal mass. This rare pathology is lacking level one evidence-based standardized treatment algorithms. The mainstay of treatment is surgical resection. Conclusion For spermatic cord liposarcomas, the surgical approach is en bloc resection with radical orchiectomy aiming for R0 margins. Prognosis depends on tumor grade, anatomic site, and the ability to achieve a microscopically tumor negative resection. Despite our patient’s disease free status, prolonged surveillance with physical examination and cross sectional imaging is still warranted.
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Affiliation(s)
- Youssef Shaban
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
| | - David Kim
- Department of Pathology, University of Texas Health Science at San Antonio (UT Health San Antonio), San Antonio, TX, USA
| | - Alia Abdulla
- Department of Surgical Oncology, Aventura Hospital and Medical Center, Aventura, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Jason Wolf
- Department of Urology, Kendall Regional Medical Center, Miami, FL, USA
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22
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Gatto L, Del Gaudio M, Ravaioli M, Cescon M, Tonini V, Cervellera M, Franceschelli A, Pirini MG, Di Scioscio V, Buia F, Niro F, Capizzi E, Fiorentino M, Astolfi A, Indio V, Nannini M, Pantaleo MA, Saponara M. Paratesticular Mesenchymal Malignancies: A Single-Center Case Series, Clinical Management, and Review of Literature. Integr Cancer Ther 2020; 19:1534735419900554. [PMID: 32009477 PMCID: PMC7050957 DOI: 10.1177/1534735419900554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Primary soft tissue sarcomas arising from the male urinary and genital tract are rare tumors, only accounting for 1% to 2% of all malignancies of the genitourinary tract. Clinical management of advanced disease is lacking in standardized recommendations due to the rarity of the disease. To date, complete and extensive surgery represents the only curative and standardized approach for localized disease, while the impact of retroperitoneal lymphadenectomy and adjuvant treatments on clinical outcomes are still unclear. Similarly, a standardized systemic treatment for advanced metastatic disease is still missing. Cases Presentation: Four out of 274 patients have been identified in our sarcoma population. The mean age was 54 years (range = 45-73). The histotypes showed liposarcoma in 2 cases and leiomyosarcoma in the remaining 2 cases. In all 4 cases, the disease was localized at presentation, patients underwent complete surgery, and no adjuvant treatments were done. Three cases presented a recurrence of disease at a mean follow-up of 86 months (range = 60-106 months), more than 7 years. Two cases were treated with a second surgery and chemotherapy and 1 case only with chemotherapy. Discussion and Conclusions: Sharing data about clinical management of paratesticular mesenchymal tumors is a key issue due to the rarity of this tumor's subtype. In this article, we report the clinical history of 4 patients affected by paratesticular mesenchymal tumor. In particular, main issues of interest are the decision of postoperative treatment and systemic treatment at time of disease recurrence.
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Affiliation(s)
- Lidia Gatto
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Valeria Tonini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Maurizio Cervellera
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Maria Giulia Pirini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Valerio Di Scioscio
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Francesco Buia
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Fabio Niro
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Elisa Capizzi
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | | | | | - Margherita Nannini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Maristella Saponara
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
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23
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Kolev N, Dunev V, Karaivanov M, Dimitrov P. Paratesticular leiomyosarcoma: A clinical case report. Urol Case Rep 2019; 27:100913. [PMID: 31687350 PMCID: PMC6819768 DOI: 10.1016/j.eucr.2019.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Abstract
We present you a Case of 62 year old man with Paratesticular leiomyosarcoma (LMS) localized to the right sctotal half. Detailed pathological and immunohistochemistry characteristic of the tumor was done. For staging was used the classification of French Federation of Cancer Centres Sarcoma Grading System. The final grading of the tumor is grade 3. Paratesticular LMS is rare identity and serves as a diagnostic and treatment challenge.
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24
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Ochi A, Toki S, Vanichakarn D, Suzuki K, Kitagawa Y, Abe H. Laparoscopic-assisted surgery for liposarcoma of the spermatic cord extending to the retroperitoneal cavity through the internal inguinal ring. IJU Case Rep 2019; 2:253-256. [PMID: 32743428 PMCID: PMC7292137 DOI: 10.1002/iju5.12084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Liposarcoma of the spermatic cord is a rare disease, reportedly treated with radical high orchiectomy. However, laparoscopic-assisted surgery for spermatic cord liposarcoma extending to the retroperitoneal cavity through the internal inguinal ring has not yet been reported. Case presentation A 78-year-old man had a spermatic cord tumor that extended to the retroperitoneal cavity through the internal inguinal ring and invaded the abdominal wall muscles. We performed laparoscopic-assisted surgery and successfully separated the tumor from the contiguous organs and vessels. The tumor was resected en bloc with abdominal wall muscles, and a muscular defect was repaired with a left tensor fascia lata muscle flap. Pathological analysis revealed a well-differentiated liposarcoma with negative surgical margins. There was no recurrence at 1 year post-surgery. Conclusion Laparoscopic-assisted surgery is a feasible and minimally invasive procedure for treating liposarcoma of the spermatic cord extending to the retroperitoneal cavity through the internal inguinal ring.
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Affiliation(s)
- Atsuhiko Ochi
- Department of Urology Kameda Medical Center Kamogawa Chiba Japan
| | - Sari Toki
- Department of Urology Kameda Medical Center Kamogawa Chiba Japan
| | | | - Koichiro Suzuki
- Department of Urology Kameda Medical Center Kamogawa Chiba Japan
| | - Yasuhide Kitagawa
- Department of Urology Komatsu Municipal Hospital Komatsu Ishikawa Japan
| | - Hirokazu Abe
- Department of Urology Kameda Medical Center Kamogawa Chiba Japan
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25
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Goldberg H, Wong LM, Dickson B, Catton C, Yap SA, Alkasab T, Evans A, van der Kwast T, Jewett MAS, Hamilton RJ. Long-term oncological outcomes of patients with paratesticular sarcoma. BJU Int 2019; 124:801-810. [DOI: 10.1111/bju.14775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hanan Goldberg
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Lih-Ming Wong
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Surgery; St. Vincent's Hospital Melbourne; University of Melbourne; Parkville Victoria Australia
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital, New York, NY, USA, and University of Toronto; Toronto ON Canada
| | - Charles Catton
- Department of Radiation Oncology; Princess Margaret Cancer Center; University Health Network; University of Toronto; Toronto ON Canada
| | - Stanley A. Yap
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Urology; University of California Davis; Sacramento CA USA
| | - Thamir Alkasab
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Andrew Evans
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Theodorus van der Kwast
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Michael A. S. Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Robert J. Hamilton
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
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26
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Erickson LA. Spermatic Cord Liposarcoma. Mayo Clin Proc 2019; 94:737-738. [PMID: 30947844 DOI: 10.1016/j.mayocp.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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27
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Abstract
Liposarcoma is the most common paratesticular scrotal malignancy. Ultrasound is the conventional imaging modality for evaluating scrotal masses. Contrast-enhanced ultrasound (CEUS) can provide complementary information by identifying distinct enhancement patterns. We present CEUS findings of 2 concurrent soft tissue masses in 1 patient: a spermatic cord well-differentiated liposarcoma and a retroperitoneal dedifferentiated liposarcoma. We review the Doppler ultrasound, computed tomography, and histopathologic appearances of low- versus high-grade liposarcomas in addition to the utility of CEUS with quantitative analysis in potentially grading liposarcomas.
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28
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Konstantinov AS, Shelekhova KV. Proliferative Funiculitis-Like Dedifferentiated Liposarcoma With Mesothelial Glandular Structures: A Diagnostic Pitfall. Int J Surg Pathol 2018; 27:271-273. [PMID: 30580648 DOI: 10.1177/1066896918820443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dedifferentiated liposarcoma shows a wide morphological spectrum. We present a case of dedifferentiated liposarcoma of the spermatic cord in a 66-year-old male that was initially misinterpreted as pseudosarcomatous proliferative funiculitis with mesothelial proliferation.
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Affiliation(s)
- Alexey S Konstantinov
- 1 Clinical Research and Practical Center for Specialized Oncological Care, Saint Petersburg, Russia.,2 Saint Petersburg Medico-Social Institute, Saint Petersburg, Russia
| | - Ksenya V Shelekhova
- 1 Clinical Research and Practical Center for Specialized Oncological Care, Saint Petersburg, Russia.,2 Saint Petersburg Medico-Social Institute, Saint Petersburg, Russia
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29
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Carrère S, Tetreau R, Honoré C, Tzanis D, Delhorme JB, Fau M, Decanter G, Llacer C, Firmin N, Stoeckle E, Meeus P, Ferron G, Cupissol D, Quénet F, Meunier B, Bonvalot S. [What is the best management for a spermatic cord sarcoma in 2018?]. Prog Urol 2018; 29:12-17. [PMID: 30340845 DOI: 10.1016/j.purol.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022]
Abstract
Spermatic cord sarcomas are rare tumors for which the most important is the initial diagnostic procedure. They are frequently misdiagnosed after surgery for inguinal hernia, inguinal lymphadenectomy or testicular malignancy. Any clinical suspicion has to lead to perform imaging with MRI and a core needle biopsy in order to obtain an accurate preoperative diagnosis. Liposarcoma and leiomyosarcoma are the most common histological subtypes in elderly adults, rhabdomyosarcoma in children or in young adults. A CT scan will precede the treatment in order to look for distant metastasis and abdominal involvement. The therapeutic strategy as well as the surgical planning are then adapted to the histological, morphological and prognostic factors. Surgery is the cornerstone for the treatment of spermatic cord sarcoma. The minimum requirements for the surgical procedure are a wide excision of the tumor en bloc with radical orchidectomy, excision of the ipsilateral scrotum and high spermatic cord ligation. It could be enlarged to the anterior abdominal wall and adjacent organs some required a soft tissue flap. Spermatic cord sarcoma and trunk wall sarcoma have the same prognosis for which local recurrence could significantly decrease survival. Consequently, surgeon in charge with these tumors has to be familiar with soft tissue sarcoma and the management of these patients must be carried out under the supervision of a multidisciplinary team within the Netsarc network.
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Affiliation(s)
- S Carrère
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France.
| | - R Tetreau
- Service de radiologie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - C Honoré
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - D Tzanis
- Service de chirurgie, institut Gustave Roussy (IGR), 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - J-B Delhorme
- Service de chirurgie, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - M Fau
- Service de chirurgie, centre Alexis Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - G Decanter
- Service de chirurgie, centre Oscar Lambret, 3, rue Fréderic Combemale, 59000 Lille, France
| | - C Llacer
- Service de radiothérapie, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - N Firmin
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - E Stoeckle
- Service de chirurgie, insitut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène Jollio-Curie, 31059 Toulouse cedex 9, France
| | - D Cupissol
- Service d'oncologie médicale, institut régional du cancer de Montpellier (IRCM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - F Quénet
- Service de chirurgie, institut régional du cancer de Montpellier (ICM), 208, avenue des apothicaires, 34298 Montpellier, France
| | - B Meunier
- Service de chirurgie, centre hospitalo-universitaire de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
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30
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Abstract
PURPOSE OF REVIEW Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT. RECENT FINDINGS Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available. SUMMARY SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.
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31
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Yamamichi G, Nakata W, Yamamoto A, Tsujimura G, Tsujimoto Y, Nin M, Tsujihata M. Liposarcoma of the spermatic cord associated with scrotum lipoma: A case report and review of the literature. Urol Case Rep 2018. [PMID: 29541595 PMCID: PMC5849877 DOI: 10.1016/j.eucr.2018.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Liposarcoma of the spermatic cord is a rare disease and often mistakenly diagnosed as inguinal hernia, hydrocele, and lipoma. We report the case of a 58-year-old man who presented with persistent discomfort and swelling on the left inguinal region. He was diagnosed with left scrotum lipoma when he was 12 years old. He underwent high orchiectomy and wide resection of the inguinal tumor. Histopathological examination revealed a well-differentiated liposarcoma of the spermatic cord with negative resection margin and scrotum lipoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with scrotum lipoma in English literature.
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32
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Morozumi K, Kawasaki Y, Kaiho Y, Kawamorita N, Fujishima F, Watanabe M, Arai Y. Dedifferentiated Liposarcoma in the Spermatic Cord Finally Diagnosed at 7th Resection of Recurrence: A Case Report and Bibliographic Consideration. Case Rep Oncol 2017; 10:713-719. [PMID: 28878655 PMCID: PMC5582524 DOI: 10.1159/000479364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 12/02/2022] Open
Abstract
Liposarcoma in the spermatic cord is infrequent, and accurate diagnosis of histopathological subtype is often difficult in spite of the importance of differential diagnosis for adequate treatment. A 54-year-old man underwent left-sided high orchiectomy with inguinal lymphadenectomy for a spermatic cord tumor in July 2006. The initial histopathological report diagnosed leiomyosarcoma in the spermatic cord. He then underwent surgeries for repeated recurrences a further 6 times between July 2008 and May 2014. Pathological finding at the 7th resection of the recurrent tumor was osteosarcoma, which was uncommon in the spermatic cord. With a thorough overview of all specimens, the histopathological diagnosis was finally confirmed as dedifferentiated liposarcoma because of a biphasic pattern in the specimen of high orchiectomy at the first resection. A biphasic pattern represents high-grade sarcoma like osteosarcoma and well-differentiated liposarcoma, and is characteristic of dedifferentiated liposarcoma. Although the dedifferentiated type is one of poor prognosis, the diagnosing of liposarcoma histopathologically was found to be difficult throughout this case. In this report we discuss the accurate histopathological diagnosis of liposarcoma in the spermatic cord in order to prevent repeated recurrences based on a review of the literature, as well as the difficulty in recognizing dedifferentiated liposarcoma macroscopically and morphologically. Our experience suggests that, after much difficulty, accurate histopathological diagnosis of liposarcoma in the spermatic cord is still clinically challenging.
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Affiliation(s)
- Kento Morozumi
- Department of Urology, Japan Community Healthcare Organization, Sendai Hospital, Sendai, Japan
| | - Yoshihide Kawasaki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Mika Watanabe
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Yoichi Arai
- Tohoku University Graduate School of Medicine, Sendai, Japan
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33
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Ford S, Almond L, Gronchi A. An Update on Non-extremity Soft Tissue Sarcomas. Clin Oncol (R Coll Radiol) 2017; 29:516-527. [DOI: 10.1016/j.clon.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 12/18/2022]
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34
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Elhajjar I, Sayyid K, Mugharbil A, Abtar HK. First reported case of paratesticular seminoma in a postpubertal cryptorchid testis. J Surg Case Rep 2017; 2017:rjx088. [PMID: 28698791 PMCID: PMC5499890 DOI: 10.1093/jscr/rjx088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/09/2017] [Indexed: 11/12/2022] Open
Abstract
Cryptorchidism is a very common anomaly, affecting 2-4% of male infants and is more common in premature infants. The long-term outcome despite orchidopexy still remains problematic and controversial with a risk of developing cancer 5-10 times greater than normal. Paratesticular tumors are mostly benign and very rare in children however malignant paratesticular tumors do arise, the most common being rhabdomyosarcoma. Primary paratesticular seminoma is extremely rare by itself and in most cases is associated with foci of seminoma within the testis. To the best of our knowledge, our case represents the fourth reported case of paratesticular seminoma in the published literature and being the first one in cryptorchid testis.
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Affiliation(s)
- Imad Elhajjar
- Department of Urology, Makassed General Hospital, Beirut, Lebanon
| | - Khalid Sayyid
- Department of Urology, Makassed General Hospital, Beirut, Lebanon
| | - Anas Mugharbil
- Department of Oncology, Makassed General Hospital, Beirut, Lebanon
| | - Houssam Khodor Abtar
- Department of Surgery, Makassed General Hospital, Beirut, Lebanon
- Correspondence address. Makassed General Hospital, PO Box 11-6301 Riad EI-Solh, 11072210 Beirut, Lebanon. Tel: +961-163-6000; Personnel Phone number: +961-70-858-658; E-mail:
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35
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Secil M, Bertolotto M, Rocher L, Pekindil G, Stocca T, Richenberg J, Ramchandani P, Derchi LE. Imaging Features of Paratesticular Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1487-1509. [PMID: 28370138 DOI: 10.7863/ultra.16.07015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/13/2016] [Indexed: 06/07/2023]
Abstract
In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non-neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented.
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Affiliation(s)
- Mustafa Secil
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Gokhan Pekindil
- Department of Radiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tiziano Stocca
- Department of Radiology, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, England
| | - Parvati Ramchandani
- Department of Genitourinary Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Lorenzo E Derchi
- Department of Radiology, Dipartimento di Scienze Della Salute, University of Genoa, Genoa, Italy
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36
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Wang X, Tu X, Tan P, Zhan W, Nie P, Wei B, Li X, Chen L, Lu Y, Han P. Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high-volume institution. Int J Urol 2017; 24:425-431. [PMID: 28470716 DOI: 10.1111/iju.13345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/05/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To report our institutional experience in the management of adult genitourinary sarcoma. METHODS This was a retrospective analysis of data on adult genitourinary sarcoma treated at the West China Hospital, Sichuan University, Chengdu, Sichuan, China from 1985 to 2010. Clinicopathological parameters were analyzed to determine their impact on overall, recurrence-free and metastasis-free survivals. RESULTS A total of 46 women and 142 men were included, with a median age of 42 years. Of these, 152 cases were high-grade. The most common site was the paratesticular region. Surgical resection was carried out in 155 patients (82.4%), with negative margin in 106. After a minimum follow up of 5 years, 20 patients (11.6%) survived disease-free, 14 (8.1%) were alive with disease and 138 (80.2%) died of disease. Survival rates at 1, 3 and 5 years were 91.3%, 64.0% and 47.7%. In univariate analyses, liposarcoma, high grade, metastasis at diagnosis, a lack of surgical resection and positive margin were predictive of unfavorable survival. In multivariate analyses, high grade, a lack of surgical resection and chemotherapy were independent predictors of poor survival. CONCLUSIONS Adult genitourinary sarcoma is an aggressive malignancy, usually presenting at advanced stage, with a high incidence of recurrence and metastasis. Complete resection and selective combination of chemotherapy and radiotherapy might constitute the optimal treatment for this disease.
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Affiliation(s)
- Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Tu
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ping Tan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Zhan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Pan Nie
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Bing Wei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Libo Chen
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yiping Lu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Han
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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37
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Rare Case of a Well-Differentiated Paratesticular Sarcoma of the Spermatic Cord in a 60-Year-Old Patient. Case Rep Urol 2017; 2017:7903242. [PMID: 28352488 PMCID: PMC5352881 DOI: 10.1155/2017/7903242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Liposarcomas are tumors that occur mostly in the retroperitoneum. Of all liposarcomas only 3 to 7% are found in the paratesticular region. The spermatic cord is the main site of origin in these cases. The patients ages range from 50 to 60 years. This malignant disease can result in a loss of fertility aside from life-threatening sequelae. Case. We present a case of a liposarcoma of the paratesticular region. A 60-year-old man was referred with a painless mass in the scrotum and the right inguinal region. The patient underwent surgery and the mass was removed along with the right testis, the spermatic cord, and the soft tissues to the internal inguinal ring. Histopathological examination found a well-differentiated liposarcoma of 80⁎80 mm. The surgical margins were negative. The adjuvant treatment consisted in radiation therapy of the right inguinoscrotal area to the dose of 54 Gray, 2 Gy per session, 5 times a week. Conclusion. Paratesticular liposarcomas are rare tumors. Surgery with large margin resections was the main treatment in all reported cases. The adjuvant treatment is still unclear especially when the surgical margins are negative. The main factor that indicated this adjuvant treatment was the size of the tumor and the histologic subtype.
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38
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Dagur G, Gandhi J, Kapadia K, Inam R, Smith NL, Joshi G, Khan SA. Neoplastic diseases of the spermatic cord: an overview of pathological features, evaluation, and management. Transl Androl Urol 2017; 6:101-110. [PMID: 28217455 PMCID: PMC5313312 DOI: 10.21037/tau.2017.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extracellular tumors found with the spermatic cord, known as neoplasms, are usually identified to be benign. However, the accurate and timely diagnosis of spermatic cord masses is highly crucial, especially when most results are often overlooked or unclear. In this review, we discuss the anatomy and embryology of the spermatic cord. Upon rooting these fundamental concepts, we discuss an array of benign and malignant neoplastic tumors, including their origin, pathological features, clinical evaluation and management, as well as other case-specific characteristics of unique presentation. Many of these neoplasms are based on local neurological, vascular, muscular, bone, soft tissue, or lymphatic origin, while others have metastasized from particular areas of the body.
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Affiliation(s)
- Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Kailash Kapadia
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Rafid Inam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA;; Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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39
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Das M, Parvin T, Bandyopadhyay A, Chatterjee U. Paratesticular liposarcoma in an adolescent male: Case report of a rare tumor. CLINICAL CANCER INVESTIGATION JOURNAL 2017. [DOI: 10.4103/ccij.ccij_45_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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[A CASE OF WELL-DIFFERENTIATED LIPOSARCOMA IN THE RIGHT SCROTUM, DIAGNOSED AFTER LOCAL TUMOR EXCISION]. Nihon Hinyokika Gakkai Zasshi 2017; 108:220-224. [PMID: 30333446 DOI: 10.5980/jpnjurol.108.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 71-year-old male was referred to our hospital with right scrotal swelling. The ultrasonography and magnetic resonance imaging revealed a 6.5 cm mass adjacent to the right testicle. Under the preoperative diagnosis of benign intrascrotal lipoma, local tumor excision through scrotal skin incision was performed. The histopathological examination revealed atypical lipomatous tumor/well-differentiated liposarcoma. With the evidence of malignancy, two-stage surgery was mandatory. Thus, radical orchiectomy with high cord ligation and wide excision of surrounding soft tissue structures through inguinal skin incision was performed. However, there were no tumor cells remaining in the resected samples. Neither adjuvant radiation therapy nor chemotherapy has been performed since contrast computed tomography showed no evidence of metastasis. He is free of disease at 1 year postoperatively.
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41
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Verghese M, Hwang J. Specific Surgical Topics: A Multidisciplinary Management of Paratesticular Sarcomas in Adults. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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42
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Cerda T, Martin É, Truc G, Créhange G, Maingon P. Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma. Cancer Radiother 2016; 21:16-20. [PMID: 28041814 DOI: 10.1016/j.canrad.2016.07.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. PATIENTS AND METHODS Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery. RESULTS Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up. CONCLUSION No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
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Affiliation(s)
- T Cerda
- Department of Radiation Oncology, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Truc
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Créhange
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Medical Imaging group, laboratoire électronique, informatique et image (Le2I) UMR 6306, CNRS, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, Arts et Métiers, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, UFR Sciences et Techniques, université de Bourgogne-Franche-Comté, allée Alain-Savary, 21000 Dijon, France
| | - P Maingon
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
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Hugar LA, Quiroga-Garza GM, Davies BJ, Hrebinko RL, Tran T, Jacobs BL. Molecular Cytogenetics as a Diagnostic Aid for Primary Liposarcoma of the Spermatic Cord. Clin Genitourin Cancer 2016; 15:e83-e89. [PMID: 27666164 DOI: 10.1016/j.clgc.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lee A Hugar
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald L Hrebinko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Thu Tran
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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44
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Sopeña-Sutil R, Silan F, Butron-Vila MT, Guerrero-Ramos F, Lagaron-Comba E, Passas-Martinez J. Multidisciplinary approach to giant paratesticular liposarcoma. Can Urol Assoc J 2016; 10:E316-E319. [PMID: 27695588 DOI: 10.5489/cuaj.3346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary paratesticular tumours are very rare and the spermatic cord (SCT) is the most frequent site of origin, with 20% of malignancy. Although liposarcoma is the most frequent histotype (46.6 %), less than 200 cases have been reported in the literature. We report the case of a 56-year-old man who presented a giant scrotal mass of 25 years of evolution and measuring 40 × 40 cm. It could be considered the greatest paratesticular liposarcoma described to date. Computed tomogaphy (CT) revealed mass features consistent with liposarcoma and the simultaneous presence of bilateral inguinal hernia with bladder involvement. A multidisciplinary approach was taken to remove the mass, solve the hernia, and provide functional results.
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Abstract
The management of truncal sarcoma presents unique challenges to the treating physician for reasons specific to this tumor location. First, the reconstruction options after resection of the abdominal or chest wall require a balance between cosmesis and structural integrity due to the multiplanar forces exerted on this region. Second, the histologies that commonly arise in this region are often associated with high local recurrence rates, which often require complex decision making due to prior therapy. Finally, sarcomas of the trunk in the inguinal region involve those organs in the genitourinary system, of which resection can have significant psychosocial implications.
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Affiliation(s)
- John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33606, USA
| | - Ricardo J Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33606, USA.
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46
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Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention--An Institutional Experience. Int J Surg Oncol 2016; 2016:4785394. [PMID: 27190644 PMCID: PMC4848420 DOI: 10.1155/2016/4785394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/14/2016] [Accepted: 03/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation. Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined. Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%. Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins.
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47
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Malignant Fibrous Histiocytoma of the Testicular Appendages Mimicking an Obstructed Hernia in an Elderly Man: Case Report and Review of the Literature. Clin Genitourin Cancer 2016; 14:e195-7. [PMID: 26953736 DOI: 10.1016/j.clgc.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/03/2015] [Indexed: 11/21/2022]
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48
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Chan DKH, Durai P, Parameswaran R. Liposarcoma of the cord treated with surgery alone: Our experience of five patients. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815604064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Liposarcoma of the spermatic cord is a rare condition presenting as an inguinal or scrotal mass. We describe our experience in the management of five patients diagnosed with this disease. Methods: We conducted a retrospective analysis of patients who underwent treatment for the condition between 2011 and 2014. Demographic data collected included the patient’s age, presentation, site of tumour, tumour size and grade and World Health Organisation (WHO) histotypes. Adequacy of tumour resection and the use of adjuvant chemotherapy or radiotherapy were also recorded. The study end points included duration of disease-free survival (DFS) as well as overall survival (OS). Results: During the study period we identified five patients with a diagnosis of liposarcoma of the cord with a median age of 67 (range 33–72) years. Three patients presented with primary disease and two were diagnosed post-resection and required re-excision to obtain R0 resection margins. Three patients had well-differentiated and two patients had dedifferentiated liposarcoma. None of the patients required adjuvant chemotherapy or radiotherapy following achievement of R0 resection margins and developed loco-regional recurrence or distant metastases. Median DFS was 30 (range 10–45) months. Conclusion: Liposarcomas of the cord are rare soft-tissue sarcomas with a high incidence of recurrence. Treatment of choice is radical orchidectomy, wide excision of the tumour and high ligation of the spermatic cord. Long-term follow-up is necessary.
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Affiliation(s)
| | - Pradeep Durai
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Rajeev Parameswaran
- Department of Endocrine Surgery, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University Hospital, Singapore
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Brandt MP, Hoefner T, Gust KM, Ahrens M, Boettcher M, Kvasnicka HM, Bartsch G, Thomas C, Haferkamp A, Tsaur I. Rare Case of Excessive Beta-Human Chorionic Gonadotropin Producing Intrascrotal Leiomyosarcoma: Diagnostic Pitfalls and Therapeutic Implications. Clin Genitourin Cancer 2016; 14:e409-12. [PMID: 26873434 DOI: 10.1016/j.clgc.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Maximilian Peter Brandt
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Thomas Hoefner
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Kilian Martin Gust
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marit Ahrens
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Marie Boettcher
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Hans-Michael Kvasnicka
- Dr. Senckenberg Institute for Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Bartsch
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Thomas
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Axel Haferkamp
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Igor Tsaur
- University Clinic for Urology and Pediatric Urology, University Hospital Frankfurt, Frankfurt, Germany
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Mykoniatis I, Metaxa L, Nikolaou V, Filintatzi C, Kikidakis D, Sountoulides P. Giant Scrotal Fibrolipoma. Rare Tumors 2015; 7:6001. [PMID: 26788275 PMCID: PMC4703921 DOI: 10.4081/rt.2015.6001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/16/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022] Open
Abstract
Fibrolipoma, an infrequent histological subtype of lipoma, is considered a benign mesenchymal neoplasm. Fibrolipoma of the scrotum is an even more rare entity. We report a case of a 55-year-old male complaining for a slow-growing, painless mass in his left hemis-crotum. Imaging with ultrasonography and magnetic resonance imaging was inconclusive regarding the nature of the tumor and the tumor was excised, sparing the testis. The surgical specimen was a well-defined, yellowish white, solid, and firm mass, measuring 19.5×7×5 cm. There was no cytological atypia or mitosis and no lipoblasts recognized. On immunohistochemistry, MDM2 and CDK4 were not expressed. The histopathology report was fibrolipoma of the scrotum. To the best of our knowledge, this is only the fourth case of fibrolipoma originating from the scrotal components, spermatic cord or testis that has been reported in the English literature.
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Affiliation(s)
| | - Linda Metaxa
- Radiology Department, AHEPA University Hospital , Thessaloniki, Greece
| | - Vasilios Nikolaou
- Urology Department, General Hospital of Veria , Thessaloniki, Greece
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