原發自精索的脂肪肉瘤 – 病例報告
郭謹瑋、林介山、歐宴泉
彰化基督教醫院 外科部 泌尿科
Liposarcoma of spermatic cord – case report
Chin-Wei Kuo1, Jensen Lin1, Yen-Chuan Ou2
Divisions of Urology1, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
. Divisions of Urology2, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Introduction
Liposarcoma of the spermatic cord is a rare tumor. It is a malignant neoplasm of adipose tissue arising from primitive mesenchymal cell. It is accounting for about 3-7% of all liposarcoma. We present one case that had solid tumor over spermatic cord and was diagnosed as dedifferented liposarcoma.
Case presentation
A 70 year old male who had a painless hard nodule over right epididymal area. Scrotal sona revealed one heteroechoic lesion. Physical examination showed one hard, elastic, and movable nodule, about 1.5 cm in diameter. He received tumor excision and one 2.5 cm solid tumor was noted next to spermatic cord with hard consistence. Adjacent tissue and epididymis seemed normal expression. The pathological report revealed dedifferentiated liposarcoma of spermatic cord. Followed CT showed abnormal fatty component in right aspect scrotum, compatible with liposarcoma recurrence. Right radical orchidectomy was advised and he received operation at TVGH. Fat like soft tissue was identified around spermatic cord. The final pathological report revealed well differentiated liposarcoma, however, the circumferential margin is involved by tumor. He is under regular OPD f/u at our clinic now.
Discussion
Dedifferentiated liposarcoma of spermatic cord is a extremely rare malignant tumor. To our knowledge, there are fewer than 100 cases reported in English literature. Liposarcomas are malignant tumors derived from mesodermal tissues. The initial presentation may be solid tumor over scrotum with hard feeling. Careful clinical and radiological examination is helpful for appropriate preoperative diagnosis. The treatment strategy is radical orchiectomy and wide excision of surrounding tissues. If the margin is in doubt, adjuvant radiotherapy is indicated. Given the unfavorable prognosis of sarcomatous tumors and the high frequency of recurrence, long-term periodic follow-up is necessary.
Conclusion:
We present a rare case who had spermatic cord liposarcoma. Given the unfavorable prognosis of sarcomatous tumors and the high frequency of recurrence, all surgeons should be aware of this malignancy if patient had solid spermatic cord mass.