罕見以陰囊腫塊表現之精索靜脈腫瘤--案例報告
陳嘉宏1、張延驊1,2,3、林登龍1,2,3、陳光國1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科2書田泌尿科學研究中心3
Paratesticular dedifferentiated liposarcoma of the spermatic cord presenting as a scrotal mass ─ a case report and literature review
Chia-Hung Chen1, Yen-Hua Chang1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
Department of Urology, Taipei Veterans General Hospital1; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Introduction:
Sarcoma of spermatic cord is a rare malignancy. We reported a case of spermatic cord dedifferentiated liposarcoma presenting as scrotal mass who underwent radical orchiectomy.
Case presentation:
A 67-year-old male presented with a slow-growing, painless, left scrotal mass for 2 years. Another mass lesion over penis rapidly enlarged in past six months. He also had history of rheumatoid arthritis over left knee. There were no history of trauma, infection, weight loss. Physical examination showed a non-tender, firm left scrotal mass. Penile shift mass lesion with tortuous deviation of penis was also found. Trans-illumination testing was negative. Laboratory tests showed normal AFP(1.24 ng/mL), beta-HCG(<1.2 mIU/ml) and elevation of LDH(340 U/L)level. CT study reported soft tissue mass with fat component in left side scrotum up to 13 cm in size. Another 6.8 cm soft tissue mass over left penis was also found. There was no lymph node metastasis. After admission, the blood test including complete blood count, biochemistry, urinalysis and chest X-ray were normal. During the surgery, a 13x10x10 cm yellowish paratesticular mass was discovered. Left side radical orchiectomy with high ligation of spermatic cord was done smoothly. En bloc resection of penis tumor was also done. The gross appearance was yellowish tumor. The left testis was not infiltrated. The patient had a good postoperative clinical course without complications and discharged smoothly. Histological examination confirmed dedifferentiated liposarcoma composed of high grade hypercellular spindle cell areas. Well-differentiated liposarcoma is also present. The tumor cells are immunoreactive for CDK4 and MDM2. Sections of the testis and epididymis are unremarkable without tumor involvement.
Conclusion:
Primary paratesticular tumors accounting for 7–10% of all intrascrotal tumors. 75% of these lesions arise from the spermatic cord. 90% malignant spermatic cord tumors are sarcoma. The dedifferentiated liposarcoma were considered to be highly malignant. Based on previous experience, radical orchiectomy with wide local excision and high ligation of the spermatic cord was recommended. Frequent recurrence and spreading by direct invasion was reported, and adjuvant radiotherapy was sometimes required for regional control. There is no consensus on the benefit of adjuvant chemotherapy. Late recurrence (>10 years) have been reported. Long-term periodic follow-up is suggested.