Rare paratesticular localization of dedifferentiated liposarcoma: Case report and review of the literature

Abstract

Rationale: Dedifferentiated liposarcoma is defined as a malignant tumor that changes its shape from a well-differentiated liposarcoma to a non-liposarcomatous form. Most paratesticular liposarcomas manifest as an inguinal, painless, slow-growing mass. The standard treatment is extensive surgical excision, radiotherapy being proposed for cases with positive margins, those with recurrence, or in cases of the existence of unfavorable prognostic factors. Patient concerns: We present the case of a young patient diagnosed initially with left hydrocele, which after 2 years proved to mask a differentiated liposarcoma of the spermatic cord. The initial clinical manifestations were represented by the increase in volume of the left groin-scrotal region and pain at this level. Diagnosis: Microscopic examination in hematoxylin-eosin staining highlighted the presence of lipoblasts and fibroblasts in association with areas of hemorrhage and tumor necrosis. The performed immunohistochemical tests confirmed the diagnosis of dedifferentiated liposarcoma. To support and confirm the presence of the mouse double minute 2 homolog gene mutation, chromogenic in situ hybridization analysis was performed. Interventions: The initial treatment was the surgical one. After 2 weeks, the patient received zolendronic acid for hypercalcemia which was caused by the osseous metastasis. Outcomes: The patient died secondary to acute renal failure caused by hypercalcemia despite the treatment received. Lessons: This case underlines the importance of both the correct management of oncological patients, as well as immunohistochemical and genetic tests in the identification of prognostic factors, with the ultimate goal of administering an appropriate oncological treatment.

Recurrent paratesticular liposarcoma: a case report

“…While data on the exact pathogenic mechanism are limited, it is known that they form de novo from connective tissue surrounding the testis, epididymis, and the spermatic cord rather than by the malignant transformation of a preexisting lipoma 8 .…”

“…Owing to the non-specific nature of these manifestations, it is crucial to differentiate them preoperatively from conditions such as inguinal hernia, hematocele, hydrocele, lipoma, epididymitis, orchiepididymitis, tuberculosis, and malignant testicular lesions. Generally, these tumors remain asymptomatic for many years, with symptoms varying from 1 week to 5 years 8 , 11 .…”

“…In most cases, inguinal and scrotal masses are assessed using ultrasound to distinguish between intratesticular and extratesticular locations as well as to differentiate solid masses from cystic masses 8 . Typically, on ultrasound, these masses are represented by a hypervascular and heterogeneous appearance with hyperechoic areas, which depends on the amount of intratumoral adipose tissue present.…”

Case Report: Giant paratesticular liposarcoma was resected and refused radical orchiectomy

“…Contrast agent computed tomography is the most commonly used maging method for diagnosing possible soft tissue sarcomas of the pelvis. Nodular septa within soft tissue mild to moderately enhanced attenuation helps distinguish it from benign lipomas, In addition, CT helps determine the location, stage and follow-up after treatment ( 21 ). MRI remains to be the standard of gold for the examination of soft tissue tumours because of its higher soft tissue resolution, which helps to characterise and depict the extent of local tumour extension and hence staging ( 4 , 16 ).…”

Paratesticular Liposarcoma Presenting as an Inguinal Swelling: A Diagnostic Conundrum

“…Paratesticular tumours are defined as tumours originating within the scrotum but not from the testis. They arise from the epididymis (4%), spermatic cord (76%), and tunica vaginalis(20%) [1]. Most paratesticular tumours are seen in middle-aged and elderly men.…”