Leiomyosarcoma of the spermatic cord: case report and literature review

Abstract

The testis and epididymis were separate from the lesion. The lump was dissected from the cord structure. The cut surface was white, solid and hard to the touch. The testis was repositioned in the scrotum and the inguinal incision was closed in layers. The patient's postoperative recovery was uneventful.Microscopic examination revealed cells arranged in well defined fascicles with central hyperchromatic nuclei and a moderate amount of eosinophilic cytoplasm (Fig. 2). There were 4 mitoses per 10 high power fields. Small foci of necrosis were noted with the appearances of a spindle cell lesion of probable smooth muscle origin. The high cellularity, pleomorphism, necrosis and mitotic activity suggested this was a malignant tumour. The tumour was classified as a grade 2 (differentiation = 2, mitoses = 1, necrosis = 1) on the Fédération Nationale des Centres de Lutte Contre le Cancer system. These histological features were suggestive of a leiomyosarcoma. The immunohistochemistry revealed interlacing fascicles of smooth muscle (positive for desmin, smooth actin and negative for S 100) ( Fig. 3A and Fig. 3B). The histology showed infiltration at edges with margins positive for tumour.The diagnosis of leiomyosarcoma and positive margin on histology prompted us to refer the patient to the regional sarcoma clinic for further treatment. His staging CT san of the chest, abdomen and pelvis did not reveal any local or distant tumour. Subsequently, he underwent a left radical orchidectomy with histology showing fibrosis of the spermatic Case ReportA 51-year-old man presented with a 2-year history of painless lump in the left hemiscrotum. He had no history of trauma, sudden increase in size or associated pain. The patient denied any lower urinary tract symptoms. His previous medical history included recurrent renal stone disease. Clinical examination of the scrotum revealed a 3 cm, non-tender, firm-to-hard lump at the root of the scrotum separate from the left testis. The lump was not freely mobile and was attached to the left spermatic cord. The routine blood investigations were normal. Ultrasound scan of the scrotum showed normal appearance on the right side, with a distinct and well circumscribed 4 × 3.2 × 2.5 cm lesion of mixed heterogeneous echogenicity on the left side. It was abutting the upper pole of the left epididymal head but separate from the epididymis and the testis. The lesion itself showed increased vascularity (Fig. 1A and Fig. 1B).The patient was offered a radical orchidectomy along with excision of the spermatic cord mass, but he declined to have an orchidectomy and opted only for excision of the mass. Upon operating we discovered that he had a lump arising from the cord near the root of the left hemiscrotum. AbstractA 51-year-old man presented with a 2-year history of painless lump in the left hemiscrotum. Scrotal examination demonstrated a 3-cm, firm-to-hard mass attached to the left spermatic cord. Scrotal ultrasound scan revealed a heterogeneous mass separate from the left testis and epididymis. An orch...

Leiomyosarcoma of the spermatic cord

“…Only about 115 cases of spermatic cord leiomyosarcoma have been reported in the world literature, and only about 43 cases in the English literature. [4][5][6][7][8][9] Thus, the present case seems important, because the present case adds a case in the lists of spermatic cord leiomyosarcoma. Immunohistochemically, the present tumor was positive for vimentin, α-smooth muscle actin, h-caldesmon, desmin (focal), p53, and Ki-67 antigen (labeling = 34%), but negative for pancytokeratin AE1/3, pancytokeratin CAM5.2, KIT (CD117), CD34, S100 protein, and myoglobin.…”

“…In addition, there have been relatively a small number of case reports with an immunohistochemical studies in leiomyosarcoma of the spermatic cord. [4,9] …”

Imaging features of a huge spermatic cord leiomyosarcoma: Review of the literature

“…The dartous layer is the origin of the scrotal types. The first two aforementioned types drain into the retroperitoneal lymph nodes in contrast with the last type, which drains into the inguinal, external and internal iliac nodes [10,11] . Grading of paratesticular LMS is based on the evaluation of the number of mitoses (the mean number of mitoses in 5 HPF [high power field] in a part of tumor with the highest mitosis rate and cellularity), the percentage of necrosis and the severity of nuclear pleomorphism [3] .…”

“…Comprehension of the pattern of spread is essential, but this task is difficult by the rare occurrence of this disease. The most common means of dissemination are by regional lymph nodes spread (external, common iliac, hypogastric and retroperitoneal lymph nodes), haematogenous metastases (most commonly to the lungs) and by local extension (local infiltration of the scrotum, inguinal canal or pelvis, along the pathway of vas deferens) [11] . Involvement of the anterior abdominal wall is also possible [12] .…”

A rare case: paratesticular leiomyosarcoma

“…The epididymal and scrotal types are less frequent and they originate from the smooth muscle surrounding the basement membrane of the epididymal canal and dartos layer, respectively. 2 Most paratesticular leiomyosarcomas present as painless, slowgrowing scrotal tumors in men of middle or older age. Occurrence of this disease is rare; therefore, the mode of spread is important.…”