Large Retroperitoneal Liposarcoma Diagnosed upon Radiological Evaluation of Mild Right-Sided Inguinal Hernia

Abstract

While inguinal hernia is common in the primary care office, the differential diagnosis is extensive and includes infectious, inflammatory and neoplastic processes. Varicocele is another frequent, generally benign condition which occasionally reflects serious disease entities. Left-sided or bilateral varicoceles account for the overwhelming majority of varicoceles because the left gonadal vein drains into the left renal vein in contrast to the right gonadal vein, which drains directly into the inferior vena cava, thus making left-sided or bilateral venous congestion more likely. Presence of an uncommon unilateral right-sided varicocele thus warrants further radiological workup, in particular CT abdomen and pelvis, to evaluate for retroperitoneal pathology. We describe a case in which appropriate use of a variety of imaging modalities including testicular ultrasound and CT led to an important diagnosis of a large, well-differentiated liposarcoma in the right retroperitoneum of a patient with a right-sided groin mass.

Retroperitoneal Liposarcoma: A Concern in Inguinal Hernia Repair

“…On histological examination, most specimen was diagnosed as well-differentiated liposarcomas, comprised of 7 cases. 5,7,8,10–12 The large tumors' weight ranged widely from 1.26 kg in the presented case up to 42 kg. 9 R0 resection margins are documented in only 2 cases after primary surgery.…”

“…Mean onset of symptoms was 1 years (7 months 8 to 5 years 9 ) before presentation. Side of the body was almost evenly distributed with 5 right-sided 6–8,10 and 4 left-sided 9–13 manifestations. Three cases appeared as an incarcerated hernia, 11,14 of note one tumor appeared as a reducible hernia 8 ; the others were not documented.…”

“…Three cases appeared as an incarcerated hernia, 11,14 of note one tumor appeared as a reducible hernia 8 ; the others were not documented. In 5 cases a computed tomography scan was performed preoperatively 6,9–11,13 ; notably none of them was conducted due to the combined suspicion of an inguinal hernia and a retroperitoneal tumor. 13…”

Clinical Curative Effect of Mesalt Combined with Mepilex Dressing in Postoperative Infection of Inguinal Hernia

“…Inguinal hernia surgery incision infection can be divided into deep and shallow infection. Infection that occurs under the aponeurosis of the obliquus externus abdominis is called deep infection, while infection that occurs above the aponeurosis of the obliquus externus abdominis is called shallow infection [ 8 – 10 ]. Shallow infection without involving the patch can be cured by simple local dressing.…”

From Inguinal Hernias to Spermatic Cord Lipomas: Pearls, Pitfalls, and Mimics of Abdominal and Pelvic Hernias

“…Varicocele may be congenital due to the absence of valves within the testicular veins, or it may be secondary to extrinsic compression or increased intra-abdominal pressure. Isolated left and bilateral varicoceles may be seen in normal patients, but an isolated right varicocele should raise suspicion for an obstructing mass and warrant further workup (50).…”