病例報告：罕見睪丸旁脂肪肉瘤
陳昱廷1、侯鎮邦1、黃士強2
林口長庚紀念醫院 1外科部泌尿科，2病理科
A Rare Case Report: Well-Differentiated Paratesticular Liposarcoma of the Left Spermatic Cord in a 32-year-old Patient
Yu Ting Chen1, Chen-Pang Hou1, Shih-Chiang Huang2
1Division of Urology, Department of Surgery, and 2Department of Pathology, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
Abstract:
Retroperitoneal soft tissue sarcoma(RPS) is rare, making up just 10 to 15 percent of all soft tissue sarcomas. In adults, liposarcoma and leiomyosarcoma are the most common histological types of RPS. The spermatic cord is a rare site of origin which comprises around 3 to 7 percent of all retroperitoneal liposarcomas. We report a rare case of left spermatic cord paratesticular liposarcoma in a young patient.
A 32-year-old male patient without any family history of cancer presented with a painless left scrotal mass that progressed in half year. The tumor was irregular and hard in characteristics. The serum tumor markers such as AFP, beta-hCG, and LDH were not elevated. The testicular ultrasound revealed a tumor of 5.6 cm x 3.53 cm with heterogeneous echogenicity and irregular contour, without accumulation of paratesticular fluid. CT (Computed Tomography) revealed a mass in left scrotum with fatty component that arises from the sperm cord. The patient underwent surgery. The mass was well-defined and connected to the left spermatic cord, but it was easy to separate from the spermatic cord. The surgical margins were negative. Histopathological and immunohistochemistry examination revealed a well-differentiated liposarcoma, FNCLCC grade 1, pT2. The patient refused further adjuvant therapy and preferred watchful waiting. The patient was followed at our out-patient department and was free from local recurrence or metastasis so far.
In this article we reviewed the existing literature on the sperm cord liposarcoma's clinical behavior and current treatment options. In conclusion, Surgery with wide margin resections is the recommended treatment for paratesticular liposarcomas in current opinions. Whether or not the adjuvant therapy is beneficial when the surgical margins are negative still remains uncertain.