疝氣手術偶發精索脂肪肉瘤之案例報告

陳生文、張彰琦、陳修聖

台北市立聯合醫院忠孝院區外科部泌尿科

Incidental finding of spermatic liposarcoma during hernioplasty: A case report

Sheng-Wen Chen, Chang-Chi Chang, Shiou-Sheng Chen

Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao branch

Introduction:

    Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. We present with an surgical management scenario that a 76 year old men who suffered from left retractable inguinal mass lesion for one year and inguinal hernia was impressed at first.

Case presentation: 

This 76 year-old male had been well until one years ago, when he noted one protruding mass at the groin area, left right side. The mass was reducible by lying supine and manipulation by him. There was no bowel habit change, nausea, vomiting or abdominal pain. He denied often cough, constipation or weight bearing. He came to our OPD for evaluation. The physical examination revealed one protruding mass at the left inguinal area. However, a 5.0 x 5.0 x 2.0 cm blood supply rich, tightly adhesion with spermatic cord was found. Left orchiectomy was then performed after discussion with family. After operation, a well-differentiated liposarcoma, grade 1 of the soft tissue of the scrotum and the spermatic cord was demonstrated on pathologic report. The immunohistochemical studies of the tumor cells shows S-100+, CDK4+, MDM2+ and ALK-1-. The tumor cells present strong immunoreactivity for KI-67 (15%) which was compatible with the immune stain expression of liposarcoma.

Conclusion:

   Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. Recurrence of the disease is frequent even several years after primary therapy, therefore long-term follow-up is mandatory.