Clinical Study of Testicular Leiomyosarcoma: Our Experience

Abstract

Introduction: Leiomyosarcoma is malignant soft tissue tumor of mesenchymal origin arising from undifferentiated smooth muscle cells. Thera are two types of Leiomyosarcoma of scrotum namely para-testicular and intra-testicular. The Intra testicular tumor is relatively rare. Blood vessels or contractile cells of the seminiferous tubules is believed to be the origin of this rare tumor which is of mesenchymal origin. Objective: Prospective clinical evaluation of testicular leiomyosarcoma with retroperitoneal mass and metastasis to para-aortic and retro-caval lymph nodes. Material & Methods: All 21 consecutive patients who were diagnosed as testicular mass on evaluation from August 2018 to July 2021 were included in study after fulfillment of eligibility criteria. Prior to surgery all patients were evaluated. All patients operated with standard method of radical high inguinal orchidectomy, followed by chemo or radio therapy as and when required on further evaluation and histopathology checked. Patients demographic, clinical-pathological, testicular tumor parameters and tumor markers with perioperative data, metastatic parameters recorded prospectively and analysed. Outcome measures were demographic data, tumor response, perioperative data, complications and follow-up at 12 months. Results: In our study out of 21 patients, 13 patients (61.9%) were found to be in stage 1,4 patients (19%) were in stage 2 and another 4 patients (19%) were in stage 3 according to IGCCCG. Only 5 patients (23.8%) were found with retroperitoneal paraarotic and paracaval Lymphadenopathy. Metastasis to liver, lung, brain and major visceral organs were present in 4 of our patients (19.8%). Conclusion: As less cases have been reported so far, clinical and biological behavior of this tumor difficult to predict. Based on the literature review, the treatment of choice for an intratesticular leiomyosarcoma is a radical orchidectomy and clinico-radiological surveillance in cases at stage I. As there are no available data regarding the management of stage II or Stage III disease post radical orchidectomy.