A rare case of paratesticular leiomyosarcoma

Abstract

Paratesticular leiomyosarcoma is a rare tumour. It is seldom diagnosed pre-operatively and subsequent secondary resection is often required. Current treatment consensus comprises inguinal radical orchidectomy with high ligation of the spermatic cord. We present a case of a 74-year-old male with a 3-year history of a painless right-sided scrotal mass which following excision was found to be an epididymal leiomyosarcoma. A review of literature and treatment is presented in this article.

Epididymal leiomyosarcoma: Report of a rare case

“…13 Although chemotherapy was occasionally used, it has no role as adjuvant treatment. 1,8 In the present case, the patient did not consent to adjuvant treatment and was followed up. Loco-regional recurrence patterns which are reported in the literature include the following: scrotal, 14,15 inguinal and retro peritoneal, 13 and even gastrointestinal mucosal metastases.…”

“…However, more studies are needed in order to take evidence based approaches, a fact also mentioned in the recent case report, presenting a patient who underwent volumetric arc conformal radiotherapy, as the adjuvant treatment for para testicular sarcoma 13 . Although chemotherapy was occasionally used, it has no role as adjuvant treatment 1,8 . In the present case, the patient did not consent to adjuvant treatment and was followed up.…”

“…If scrotal invasion is present, hemiscrotectomy is indicated. 8 Kamitani et al, 2022, performed a retrospective analysis of 217 reported cases of para testicular LMS. Patients treated by simple tumorectomy were reported to have a significantly higher risk of a positive surgical margin (9 of 17 vs. 5 of 27, p = .024), which they described to be an independent risk factor for local recurrence.…”

“…Current consensus is to perform radical orchiectomy with high ligation of the spermatic cord. If scrotal invasion is present, hemiscrotectomy is indicated 8 . Kamitani et al, 2022, performed a retrospective analysis of 217 reported cases of para testicular LMS.…”

“…There is no recent evidential study on the effect of this modality on disease recurrence or patient survival, but previous studies have mentioned this option as a rational approach, considering the fact that wide resection of all the margins are difficult to achieve and the prevalence of loco‐regional recurrence after definite surgery is 30%–50% 10 . Rezvani et al 8 mentioned two historical case series that described reduced loco‐regional recurrence after adjuvant radiotherapy. In addition, authors of some previous studies, recommend that adjuvant radiotherapy should be done for all types and grades of para testicular LMS, because they observed higher local failure patterns post‐surgery 11,12 .…”