Paratesticular Sarcoma: Typical Presentation, Imaging Features, and Clinical Challenges

Dafydd, Derfel Ap; Messiou, Christina; Thway, Khin; Strauß, D.; Nicol, David; Moskovic, E.

doi:10.1016/j.urology.2016.09.005

Cited by 23 publications

(26 citation statements)

References 29 publications

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“…Over 90% of the patients in our present cohort had undergone surgery without a preoperative diagnosis of sarcoma, when the true diagnosis had not been originally suspected preoperatively. This extremely high percentage is similar to that reported in other series [8]. Our present data demonstrate that patients with PTS of all grades are at high risk of LR when not treated with wide-margins hemiscrotectomy.…”

Section: Discussionsupporting

confidence: 92%

“…Unfortunately, there are currently no clear guidelines or consensus on the optimal management strategy of PTS and the natural history of the disease is not well-known. This emanates from the rarity of these tumours and that most published data are derived from case reports and short series [1,6,8,9,11,[13][14][15]. In an attempt to improve this, raising physician awareness of these tumours is an important first step.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term oncological outcomes of patients with paratesticular sarcoma

et al. 2019

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Objectives To present long‐term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients and methods Patients managed at the Princess Margaret Cancer Centre, between 1990 and 2012, were analysed. A sarcoma expert performed central pathology review. Kaplan–Meier graphs compared local recurrence (LR), metastasis, and overall survival (OS) of patients treated with hemiscrotectomy vs those who did not. Univariable Cox proportional hazards analysis was performed to delineate predictors of LR, metastasis, and OS. Results Overall, 51 patients with a median (interquartile range) follow‐up of 132 (51.6–226.8) months were analysed. At presentation, 92.2% (47 patients) had localised disease. Only five patients (9.8%) had undergone initially planned hemiscrotectomy. Completion and salvage hemiscrotectomy was performed in 25 (54.3%) and seven (15.2%) patients, respectively. Recurrence and metastasis occurred in 12 (25.5%) and 10 patients (19.6%), respectively. At the last follow‐up, 21.6% (11 patients) had died, with eight dying from their disease. Kaplan–Meyer graphs demonstrated that hemiscrotectomy improved LR (median not reached vs 62.4 months, log‐rank P = 0.008) and OS (median not reached vs 168 months, log‐rank P = 0.081). Univariable analysis found hemiscrotectomy to be associated with a lower LR rate (hazard ratio [HR] 0.21, P = 0.02), whilst positive margins at initial surgery were associated with increased LR (HR 4.81, P = 0.047). No metastasis predictors were found, but age (HR 1.04, 95% confidence interval [CI] 1.0–1.08; P = 0.02) and non‐localised disease at presentation (HR5.17, 95% CI 1.33–20.06; P = 0.017) were associated with worse OS. Conclusion Paratesticular sarcoma is a rare tumour, predominantly manifesting as localised disease. Most patients receive an initial suboptimal oncological surgery. Improved long‐term outcomes are demonstrated following early hemiscrotectomy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Long‐term oncological outcomes of patients with paratesticular sarcoma

et al. 2019

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“…The first case of paratesticular sarcoma was reported in 1845 by Lesauvage [ 2 ]. The most common histological subtypes are liposarcoma (20–32%), LMS (19–32%) and rhabdomyosarcoma (11–24%) [ 3 ]. Only 110 cases of LMS confined to the spermatic cord have ever been reported [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

A rare case of paratesticular leiomyosarcoma

Rezvani

Bolton

Crump

2018

Journal of Surgical Case Reports

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Paratesticular leiomyosarcoma is a rare tumour. It is seldom diagnosed pre-operatively and subsequent secondary resection is often required. Current treatment consensus comprises inguinal radical orchidectomy with high ligation of the spermatic cord. We present a case of a 74-year-old male with a 3-year history of a painless right-sided scrotal mass which following excision was found to be an epididymal leiomyosarcoma. A review of literature and treatment is presented in this article.

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“…Possible extension of tumors outside the abdominal cavity through the diaphragmatic hiatus, inguinal canal, sciatic notch or obturator foramen should be described in order for surgical planning to encompass the extension into an en bloc resection . This is most commonly encountered in liposarcomas where the inguinal component can be mistaken for an inguinal hernia (Figure ).…”

Section: Assessing Operability and Minimum Reporting Requirementsmentioning

confidence: 99%

“…There is a bland retroperitoneal soft tissue mass which encases and displaces the renal vein (arrow) but does not efface it encompass the extension into an en bloc resection 24. This is most commonly encountered in liposarcomas where the inguinal component can be mistaken for an inguinal hernia36 (Figure 6).6 | RESPONSE ASSESSMENT6.Assessing response to systemic therapyConventionally response to systemic treatment is evaluated by Response Evaluation Criteria in Solid Tumors 1.137 which is based on size measurements. Where the sarcoma subtype in question is liposarcoma it is important that the dedifferentiated elements are selected as target lesions for measurement as well differentiated elements would not be expected to change on treatment.…”

mentioning

confidence: 99%

Imaging in retroperitoneal soft tissue sarcoma

Messiou

Morosi

2017

Journal of Surgical Oncology

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Patients with retroperitoneal sarcoma can present to a variety of clinicians with non‐specific symptoms and retroperitoneal sarcomas can be incidental findings. Failure to recognize retroperitoneal sarcomas on imaging can lead to inappropriate management in non‐specialist centers. Therefore it is critical that the possibility of retroperitoneal sarcoma should be considered with prompt referral to a soft tissue sarcoma unit. This review guides clinicians through a diagnostic pathway, introduces concepts in response assessment and new imaging developments.

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Paratesticular Sarcoma: Typical Presentation, Imaging Features, and Clinical Challenges

Cited by 23 publications

References 29 publications

Long‐term oncological outcomes of patients with paratesticular sarcoma

Long‐term oncological outcomes of patients with paratesticular sarcoma

A rare case of paratesticular leiomyosarcoma

Imaging in retroperitoneal soft tissue sarcoma

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