Liposarcoma scroti: a rare paratesticular tumor

Abstract

Paratesticular liposarcoma is a rare condition characterized by a growing, painless inguinal, or scrotal mass. To our knowledge, less than 200 cases worldwide are reported thus far. It is characterized by slow growth and can reach large dimensions at diagnosis. Paratesticular well-differentiated liposarcoma has a prolonged clinical course with recurrences in more than half the cases, sometimes late. Regardless of tumor size, radical orchidectomy with free surgical margins is recommended in order to avoid recurrence. When there is tumor recurrence, reoperation is the treatment of choice because radio- and chemotherapy have yet to be well established in these cases. There is a low risk of metastasis. Overall prognosis is good. Adjuvant therapies, represented by radio- and chemotherapy, have a controversial role in the literature due to the rarity of the disease. In this article, we present review of the literature and case discussion of paratesticular liposarcoma with focus on diagnosis, treatment and follow-up.

Giant paratesticular liposarcoma: A case report and review of the literature

“…When the diameter of testicular tumor reaches more than 10 cm, such size will be called 'giant' (5). As far as we know, 200 or so cases of PLS have been reported up to date (14), and giant PLS are more rare with only a few cases having been reported (2-6). The incidence of PLS has a regional difference with the highest incidence being in Japan (7).…”

“…The tumor attacked adult patients aged 50 to 60 years more frequently (15), though it occurred in patients with a range of 16 to 90 years of age on the basis of the current literature (16,17). PLS mostly present as a painless, slow-growing inguinal or inguinoscrotal mass and sometimes combine with a sensation of heaviness (9,14,16) and the occurrence of wrong diagnosis like scrotal lipoma, inguinal hernia and epididymitis before surgical intervention attribute to this clinical presentation (12,15). Most PLS are primary, but some can be metastasis from liposarcoma at other sites, such as thigh or the fatty tissue surrounding the testicle (18,19).…”

“…On US examination, PLS are identified as solid, heterogeneous solid, hypoechoic lesions, sometimes accompanied by colliquation if there is necrosis. However, US cannot always distinguish PLS from lipomas if the tumor is small or it is a well-differentiated PLS with homogenous fatty pattern, which makes PLS similar to lipoma (10,14,22). Compared to subcutaneous fatty tissue, CT usually demonstrates the tumor area with lower density.…”

“…Most PLS are primary, but some can be metastasis from liposarcoma at other sites, such as thigh or the fatty tissue surrounding the testicle (18,19). Because of the insufficient number of literature on patients with PLS, no reliable standardized diagnosis and treatment guidelines have been made (14). Ultrasonography (US), Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are documented in the diagnosis of PLS (20,21).…”

Paratesticular liposarcoma: ultrasonography findings

“…Testis-localized sarcomas are rare tumors that can interfere with other testicular malignancies (1). Liposarcoma is rare and constitutes 3-7 % of paratesticular sarcomas (2,3). The paratesticular tissue forms the spermatic cord, the testicular tunica, and the epididymis.…”