Epidydimal leiomyosarcoma: a rare case of scrotal swelling

Abstract

Sarcomas of the genitourinary tract are extremely uncommon and accounts for only 1-2% of genito urinary malignancies. Sarcomas of the para testicular region, comprising tissues such as the epididymis, spermatic cord, inguinal canal and testicular tunica are also extremely rare. epidydimal leiomyosarcoma accounted only for 4 percentage of all para testicular tumours and only 16 cases are reported so far in literature and they account 4% of all Para testicular sarcomas. We are presenting a 61-year-old patient presented with a hard welling of 1 year duration, with no other associated symptoms. On ultrasound evaluation, it was reported as extra testicular lesion, possibly from epididymal tail. We performed a high inguinal orchidectomy. Histopathological examination revealed a para testicular leiomyosarcoma arising from epididymis. This case has discussed because of the rarity of the disease and possible cure if diagnosed early and treated aggressively.

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.…”

“…Considering the high risk of loco-regional recurrence, adjuvant radiotherapy has been proposed as a useful option. 1 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.…”

“…Para testicular region contains different elements histologically, including epithelial, mesothelial, and mesenchymal tissues, which give rise to a few rare but histologically diverse tumors, 1 with different behavioral patterns and diverse biology 2,3 …”

“…Sarcomas of the genitourinary tract are rare and account for only 1%-2% of genitourinary malignancies. 1 According to a large case series from the Memorial Sloan-Kettering Cancer Center, 2.1% of soft tissue sarcomas arise in the genitourinary tract, of which 44% are para testicular, and leiomyosarcoma (LMS) is the most common type of para testicular sarcoma. 2 There are no specific clinical findings to distinguish the type or the difference between this pathology and a benign tumor.…”