51
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Khandekar MJ, Raut CP, Hornick JL, Wang Q, Alexander BM, Baldini EH. Paratesticular liposarcoma: unusual patterns of recurrence and importance of margins. Ann Surg Oncol 2013; 20:2148-55. [PMID: 23591942 DOI: 10.1245/s10434-013-2963-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Paratesticular liposarcoma (LPS) is a rare entity for which optimal treatment has not been defined. We sought to determine recurrence patterns and prognostic factors. METHODS A total of 25 patients with localized paratesticular LPS between 1987 and 2009 were reviewed. Actuarial local-recurrence-free survival (LRFS), disease-free-survival (DFS), and overall survival (OS) were determined using the Kaplan-Meier method. RESULTS LPS histology was well differentiated for 10 patients (40 %), de-differentiated for 14 (56 %), and pleomorphic for 1 (4 %). Final margins were positive in 8 patients (32 %). Radiation therapy (RT) was given to 10 patients; fields included inguinal canal ± scrotum and low pelvis. LRFS rates at 3 and 5 years were 76 and 67 %. The 3-year LRFS rates were lower in patients with positive margins compared with those with negative margins (29 vs 100 %, p = .0005) and in patients with recurrent versus primary disease (38 vs 83 %, p = .04). Among patients who received surgery and RT, margins remained a significant predictor of local recurrence (p = .009). Interestingly, recurrences in 4 patients tracked along gonadal vessels, and only 1 patient had a distant recurrence. OS at 5 years was 100 %. CONCLUSIONS For patients with localized paratesticular LPS, positive margins and presentation with recurrent disease are adverse prognostic factors for LRFS. LR for patients with positive margins is still high despite RT; thus aggressive surgery to attain negative margins should be attempted in all cases. The finding of regional recurrences along gonadal vessels should be validated, and imaging studies should be tailored to reflect potential patterns of disease at presentation and subsequent recurrence.
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Affiliation(s)
- Melin J Khandekar
- Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA, USA
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52
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Govardhane P, Zafar FA, Geelani IA, Girish H, Sharma D, Rajagopal V, Swain M, Swarnalatha G. Liposarcoma of spermatic cord – A rare entity. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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53
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Aziz R, Jamil A, Alubaidi K, Jamil W. Liposarcoma of the spermatic cord. BMJ Case Rep 2013; 2013:bcr-2012-008141. [PMID: 23429020 DOI: 10.1136/bcr-2012-008141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 43-years-old male patient presented through general practitioner with a complaint of right scrotal mass and was operated through inguinal approach. A 4 cm mass was excised and was found to be a liposarcoma of the spermatic cord upon histopathology, which is a diagnostic dilemma and very rare entity.
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Affiliation(s)
- Rizwan Aziz
- Department of Surgery, South West Acute Hospital, Enniskillen, UK.
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54
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Guttilla A, Crestani A, Zattoni F, Secco S, Iafrate M, Vianello F, Valotto C, Prayer-Galetti T, Zattoni F. Spermatic Cord Sarcoma: Our Experience and Review of the Literature. Urol Int 2013; 90:101-5. [DOI: 10.1159/000343277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
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55
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Abstract
Primary spermatic cord tumors are rare yet clinically significant urologic lesions that affect patients of all ages. They are the most common tumors of the paratesticular region and generally present as asymptomatic, slow growing, firm, palpable paratesticular masses. Although most of them are benign comprised primarily of lipomas, approximately 25% are potentially life-threatening malignant tumors. The most common reported malignant histological types include liposarcomas, leiomyosarcomas, rhabdomyosarcomas, malignant fibrous histiocytoma, and fibrosarcomas. Management of these malignant tumors has been difficult because of their rarity, therefore there is little consensus regarding optimal surgical and adjunctive treatment strategies. It is recommended that radiological techniques such as scrotal ultrasound (US), computed tomography, and magnetic resonance be used to evaluate these masses before surgery. The curative treatment of choice is radical orchiectomy with high cord ligation and wide excision of surrounding soft tissue structures within the inguinal canal. Patients with inadequately resected disease should undergo a reoperative procedure for wide inguinal re-resection. Retroperitoneal lymphadenectomy is recommended when there is preoperative evidence of retroperitoneal lymph node metastasis and as an adjuvant treatment for rhabdomyosarcomas since they have a higher propensity for lymphatic spread. Adjuvant treatments, such as radiotherapy and chemotherapy, have shown little efficacy, except in the management of patients with local recurrence or high-grade rhabdomyosarcomas. Long-term follow up is recommended given their high recurrence rates.
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56
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Tearada H, Nagata M, Mugiya S, Ozono S. High-grade myxofibrosarcoma presenting at the spermatic cord after radiotherapy for prostate cancer. BMJ Case Rep 2012. [PMID: 23195821 DOI: 10.1136/bcr-03-2012-6082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 72-year-old man with a history of prostate cancer presented 7 years postradiotherapy with a painless, egg-sized, rapidly growing nodule on the left groin at the radiation site. He underwent left high orchiectomy under a diagnosis of groin lymph node metastasis of prostate cancer. The tumour had penetrated deep into the internal inguinal ring and was resected as proximally as possible to the internal ring with a positive surgical margin. Macroscopically, the left testis was intact in the resected specimen. Immunohistochemical staining revealed that the tumour consisted of myxofibrosarcoma (MFS) with spindle cells; and was positive for vimentin, cytokeratin (AE1/AE3), MIB-1 and CD68, and negative for α-SMA, S-100, CD34 and myogenin. Thus, the tumour was diagnosed as high-grade MFS of the spermatic cord. Postoperative CT revealed a right renal tumour and adrenal tumour. Right radial nephrectomy was performed and the patient was doing well at 10-month follow-up.
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Affiliation(s)
- Hiroshi Tearada
- Department of Urology, Terada Clinic, Hamamatsu, Shizuoka, Japan.
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57
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Tan CJ, Dasari BVM, Smyth J, Brown RJ. Liposarcoma of the spermatic cord: a report of two cases. Ann R Coll Surg Engl 2012; 94:e10-2. [PMID: 22524907 DOI: 10.1308/003588412x13171221498901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Liposarcomas of the spermatic cord are unusual and rarely reported in the literature. These tumours can sometimes be mistaken for the common scrotal swellings such as hydrocoeles and hernias. Careful clinical and radiological examination will help in appropriate preoperative planning and surgery by an experienced surgical team. We report our experience of two cases of such scrotal swellings.
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Affiliation(s)
- C J Tan
- Surgical Assessment Unit, Daisy Hill Hospital, Newry, UK.
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58
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Keskin S, Ekenel M, Basaran M, Kilicaslan I, Tunc M, Bavbek S. Clinicopathological characteristics and treatment outcomes of adult patients with paratesticular rhabdomyosarcoma (PRMS): A 10-year single-centre experience. Can Urol Assoc J 2012; 6:42-5. [PMID: 22396368 DOI: 10.5489/cuaj.11121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report our experience with 8 consecutive adults treated for paratesticular rhabdomyosarcoma (RMS) at a single institution between 2000 and 2010. METHODS After primary surgical excision, 7 patients were classified into group I according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) Postsurgical Grouping Classification, and 1 patient into group IIB. Retroperitoneal node dissection was not a required staging procedure. Adjuvant chemotherapy was administered to 7 of the 8 patients. No additional radiotherapy was administered. RESULTS The median age at diagnosis was 24 years (range: 18-60). Embryonal histology was the most common (75%) subtype. During follow-up, 3 patients experienced local relapse and 5 distant relapse. The median progression-free and overall survival times were 17.0 ± 9.9 months (range: 5-31) and 27.3 ± 1.3 months (range: 16-58), respectively. CONCLUSION Paratesticular RMS is an uncommon malignancy in adults. We confirm that patients with localized paratesticular RMS may have different prognoses. Retroperitoneal lymphadenectomy can be avoided as a treatment for paratesticular RMS after radical inguinal orchiectomy.
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Affiliation(s)
- Serkan Keskin
- Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey
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59
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HONG RAN, LEE GEUNJAE, KIM HYUNGSANG, KIM CHULSUNG, KEE KEUNHONG. Primary paratesticular osteosarcoma: A case report. Oncol Lett 2012; 3:554-556. [PMID: 22740950 PMCID: PMC3362649 DOI: 10.3892/ol.2011.518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/24/2011] [Indexed: 11/06/2022] Open
Abstract
Extraosseous osteosarcoma originating from paratesticular soft tissue is an extremely rare type of malignant tumor. With the exception of the present study, only one other case of osteosarcoma originating from paratesticular soft tissue has previously been reported. A 52-year-old man presented with a painless scrotal swelling and palpable mass. The patient underwent left orchiectomy with the diagnosis of testicular tumor. Pathological examination was suggestive of osteosarcoma without any different histological components. The postoperative course of the patient was uneventful, and the patient is currently free of disease.
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Affiliation(s)
- RAN HONG
- Department of Pathology, Medical School, Chosun University, Gwangju 504-140, Republic of Korea
| | - GEUNJAE LEE
- Department of Urology, Medical School, Chosun University, Gwangju 504-140, Republic of Korea
| | - HYUNGSANG KIM
- Department of Urology, Medical School, Chosun University, Gwangju 504-140, Republic of Korea
| | - CHUL-SUNG KIM
- Department of Urology, Medical School, Chosun University, Gwangju 504-140, Republic of Korea
| | - KEUN-HONG KEE
- Department of Pathology, Medical School, Chosun University, Gwangju 504-140, Republic of Korea
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60
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Rais G, Andaloussi MB, Raissouni S, Barki A, Allaoui M, Zouaidia F, Afif M, Mrabti H, Errihani H. [Dedifferentiated liposarcoma of the spermatic cord: therapeutic difficulties of large tumors]. Pan Afr Med J 2011; 8:49. [PMID: 22121456 PMCID: PMC3221406 DOI: 10.4314/pamj.v8i1.71167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 04/26/2011] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ghizlane Rais
- Service d'oncologie médicale, Institut National d'oncologie, Rabat, Morocco
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61
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Hsu YF, Chou YY, Cheng YH. Spermatic cord myxoid liposarcoma presenting as an incarcerated inguinal hernia: report of a case and review of literatures. Hernia 2011; 16:719-22. [PMID: 21387152 DOI: 10.1007/s10029-011-0803-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 02/11/2011] [Indexed: 11/29/2022]
Abstract
Incarcerated inguinal hernia is a common surgical indication in the emergency room. Delayed diagnosis can result in ischemic bowel or bowel perforation. The reported incarcerated contents include bowel loop, mesentery, omentum and, rarely, malignant lesions, such as lymphoma, metastatic tumors etc. We report a new case of primary spermatic cord liposarcoma presenting as emergent incarcerated inguinal hernia and review the related literature.
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Affiliation(s)
- Y-F Hsu
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shin Lin District, Taipei, 111, Taiwan
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62
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Kanso C, Roussel H, Zerbib M, Flam T, Debré B, Vieillefond A. Les sarcomes du cordon spermatique de l’adulte : diagnostic et prise en charge. Prog Urol 2011; 21:53-8. [DOI: 10.1016/j.purol.2010.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 04/25/2010] [Accepted: 05/09/2010] [Indexed: 11/17/2022]
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63
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Chintamani, Tandon M, Khandelwal R, Jain S, Narayan N, Kumar Y, Saxena S. Liposarcoma of the spermatic cord: a diagnostic dilemma. JRSM SHORT REPORTS 2010; 1:49. [PMID: 21234112 PMCID: PMC2994353 DOI: 10.1258/shorts.2010.010058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chintamani
- Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital , New Delhi , India
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64
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García-Fadrique G, Morán Pascual E, Morales Solchaga G, Soto A, Morera J, Jiménez-Cruz J. Liposarcoma desdiferenciado de alto grado de cordón espermático. A propósito de un caso. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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65
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Manzia TM, Gravante G, Toti L, Iaria G, Anselmo A, Fratoni S, Angelico R, Sforza D, Manuelli M, Tisone G. Management of spermatic cord liposarcoma in renal transplant recipients: case report. Transplant Proc 2010; 42:1355-7. [PMID: 20534300 DOI: 10.1016/j.transproceed.2010.03.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Herein, we report the case of a 52-year-old man with a spermatic cord liposarcoma that developed 4 years after renal transplantation. The patient was admitted with a diagnosis of inguinal hernia. During surgical exploration, a solid mass was found arising from the spermatic cord. Histologic analysis demonstrated a well-differentiated sclerosing liposarcoma.
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Affiliation(s)
- T M Manzia
- UOC Trapianti d'Organo, Sant' Eugenio Hospital, University Tor Vergata, Rome, Italy.
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66
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Abstract
Spermatic cord sarcomas (SCS) are very infrequent and sometimes misdiagnosed malignancies. Moreover, their optimal management remains undefined with ongoing controversy about the indications for adjuvant therapy. Histologically, liposarcomas are the most common type. Osteosarcoma is rarely observed in this location and combined tumours with this component have not been described. We present a case of SCS with mixed differentiation with both liposarcoma and osteosarcoma elements.
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67
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Giant lipoma of the spermatic cord. Am J Surg 2009; 198:e54-5. [PMID: 19887177 DOI: 10.1016/j.amjsurg.2009.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/27/2009] [Accepted: 02/10/2009] [Indexed: 11/21/2022]
Abstract
The authors present a case of a huge right inguinal bulge that was referred as a right inguinal hernia. At surgery, it was confirmed to be a giant lipoma of the spermatic cord. A description of the case, pictures of clinical appearance and operative specimen, and a short literature review are presented.
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68
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Juan C, Pérez A, Abad Licham M, Godoy Pow-Sang M, Destefano Urrutia V, Sánchez Lihon J. [Adult paratesticular sarcomas. Management and evolution of the disease]. Actas Urol Esp 2009; 33:639-45. [PMID: 19711747 DOI: 10.1016/s0210-4806(09)74202-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify and analyze the clinic pathologic characteristics, therapeutic, and the evolution of the disease in adult patients with a diagnosis of paratesticular sarcoma. MATERIAL AND METHODS We reviewed retrospectively the medical records of patients diagnosed with sarcoma paratesticular location of the department of urology at the National Institute of Neoplastic Diseases from 1952 to 2003. Data was collected affiliation, background, symptoms, diagnostic methods, pathological diagnosis, treatment and status of the disease. We analyzed statistically evaluated and compared with information obtained in the literature. RESULTS Sixteen paratesticular sarcomas cases were found in patients greater than 16 years old; 9 rhabdomyosarcomas, 3 leiomyosarcomas, 3 liposarcomas, and 1 nonclassifiable sarcoma. There were two thresholds of presentation, one among 16 to 20 years and another one in greater than 60 years. Six had metastatic disease at diagnosis. The average survival was 32.18 months with a range among 1 and 142, only two patients are alive, a case of rhabdomyosarcoma without disease evidence and another one of leiomyosarcoma with inguinal recurrence. CONCLUSIONS Paratesticular sarcoma is a rare malignant neoplasia of poor prognostic with variable history of disease in relation a histology subtype, but in general of bad evolution with fatal ending. The biological behavior of the tumor and history of the disease vary according to histological subtype, but in general the trend is poor with fatal outcome.
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69
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Chung HC, Lee HS, Kim TI, Eom MS, Song JM. Local Recurrence of Spermatic Cord Leiomyosarcoma. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.1.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyun Chul Chung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyo Serk Lee
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Im Kim
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Eom
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Mann Song
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
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70
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Ruiz Liso J, Pardo López M, Vaillo Vinagre A, Gutiérrez Martín A, Bermúdez Villaverde R, Ruiz García J. [Long-term paratesticular leiomyosarcoma. Conceptual and literature review]. Actas Urol Esp 2008; 32:727-36. [PMID: 18788490 DOI: 10.1016/s0210-4806(08)73922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION To know the incidence and clinical and pathologic characteristics of the paratesticular leiomyosarcoma (LMS) with the contribution of a case of long evolution, studying the histopathologic criteria that must be valued for this type of tumours. MATERIAL AND METHODS A 73-year-old patient includes for study with scrotal tumour present left side for 30 months. Histopathologic and imunohistochemical study is realized. Of equal form there is realized a bibliographical search of this type of tumours and their different subtypes across Medline and of not index-linked search. RESULTS Our case is the second of greater evolution of international literature, first in greater of 60 years and one of those of smaller mitotic index (1 x 50 cga). Nevertheless, his atipia, tumorlike necrosis next to 50% of the injury and its pleomorphic properties, as well as his inmunophenotypic characterization corresponds with a well differentiated LMS, degree 1 (French Federation Cancer). We have found only 107 published cases of this type of sarcomas, of them 5 in our country, which gives to a profile of the low incidence of these tumours, that within sarcomas 1% do not reach. We included the clinical and pathologic profile of such. CONCLUSIONS The long evolution of a paratesticular tumour and the absence of metastasis does not exclude its malignancy. The low incident of the LMSs in this location, implies that a protocol of actuation validate for such does not exist. We considered of great importance, its creation on the part of urologist, oncologists, radiologists and pathologists like he took control of located in retroperitoneal cavity and deep soft tissues.
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71
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Bhosale PR, Patnana M, Viswanathan C, Szklaruk J. The inguinal canal: anatomy and imaging features of common and uncommon masses. Radiographics 2008; 28:819-35; quiz 913. [PMID: 18480486 DOI: 10.1148/rg.283075110] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A variety of benign and malignant masses can be found in the inguinal canal (IC). Benign causes of masses in the IC include spermatic cord lipoma, hematoma, abscess, neurofibroma, varicocele, desmoid tumor, air, bowel contrast material, hydrocele, and prostheses. Primary neoplasms of the IC include liposarcoma, Burkitt lymphoma, testicular carcinoma, and sarcoma. Metastases to the IC can occur from alveolar rhabdomyosarcoma, monophasic sarcoma, prostate cancer, Wilms tumor, carcinoid tumor, melanoma, or pancreatic cancer. In patients with a known malignancy and peritoneal carcinomatosis, the diagnosis of metastases can be suggested when a mass is detected in the IC. When peritoneal disease is not evident, a mass in the IC is indicative of stage IV disease and may significantly alter clinical and surgical treatment of the patient. A combination of the clinical history, symptoms, laboratory values, and radiologic features aids the radiologist in accurately diagnosing mass lesions of the IC. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/28/3/819/DC1.
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Affiliation(s)
- Priya R Bhosale
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 368, Houston, TX 77030, USA.
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72
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Müller Arteaga C, Egea Camacho J, Alvarez Gago T, Cortiñas González JR, Gonzalo Rodríguez V, Fernández del Busto E. [Spermatic cord liposarcoma. Association with prostate cancer. Report of a case and review of literature]. Actas Urol Esp 2005; 29:700-3. [PMID: 16180322 DOI: 10.1016/s0210-4806(05)73322-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Spermatic Cord Liposarcoma are uncommon soft tissue neoplasm. Association with others tumors is so exceptional. We describe and relation between liposarcoma and prostate cancer in a 66 years old patient who had a left paratesticular tumor with low speed growth and 12 cm of length; nodule in prostate gland was detected. Ecography demostrate an hipoecoic tumor in the spermatic cord; Prostate Specific Antigen (PSA) was 1276 ng./ml. and bone gammagraphy reported metastatic lesions. We made an radical orquiectomy and pathological diagnosis including inmunohistoquimical process was sclerosing dedifferenciated liposarcoma. We discuss clinical and pathologic behaviour of this lesions and diagnosis and treatment options.
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Affiliation(s)
- C Müller Arteaga
- Servicio de Urologia, Hospital Clínico Universitario de Valladolid
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73
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Enoch S, Wharton SM, Murray DS. Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery. World J Surg Oncol 2005; 3:23. [PMID: 15860129 PMCID: PMC1097762 DOI: 10.1186/1477-7819-3-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Accepted: 04/28/2005] [Indexed: 01/09/2023] Open
Abstract
Background Leiomyosarcomas (LMS) of the spermatic cord are extremely rare. Radical inguinal orchiectomy and high ligation of the cord is the standard primary surgical procedure. The extent of surrounding soft tissue excision required and the precise role of adjuvant radiotherapy, however, remains unclear. In addition, recurrence is a commonly encountered problem which might necessitate further radical excision of adjacent soft tissues. Methods This article reviews the pathophysiology of spermatic cord leiomyosarcomas (LMS), and discusses the various reconstructive surgical options available to repair the inguinal region and the lower anterior abdominal wall after excision of the tumour and the adjacent soft tissues. Results There is paucity of literature on LMS of spermatic cord. The majority of paratesticular neoplasms are of mesenchymal origin and up to 30% of these are malignant. In adults, approximately 10% of spermatic cord sarcomas are LMS. Approximately 50% of these tumours recur loco-regionally following definitive surgery; however, the incidence decreases if resection is followed by adjuvant radiotherapy. Conclusion It is therefore important to achieve negative histological margins during the primary surgical procedure, even if adjuvant radiotherapy is instituted. If extensive resection is required, either during the primary procedure or following recurrence, reconstructive surgery may become necessary. This article reviews the pathophysiology of spermatic cord LMS, the reasons for recurrence, and discusses the management options including the role of reconstructive surgery.
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Affiliation(s)
- Stuart Enoch
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
- Wound Healing Research Unit, University Department of Surgery, University of Cardiff/University Hospital of Wales, Cardiff, – CF14 4UJ, UK
| | - Simon M Wharton
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
| | - Douglas S Murray
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
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74
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Mack LA, Temple WJ, DeHaas WG, Schachar N, Morris DG, Kurien E. Groin soft tissue tumors?a challenge for local control and reconstruction: A prospective cohort analysis. J Surg Oncol 2004; 86:147-51. [PMID: 15170653 DOI: 10.1002/jso.20058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Groin soft tissue tumors are associated with high local recurrence rates of 16-48% and postoperative complications in 40-68%. Neoadjuvant chemoradiation and aggressive reconstructive techniques were utilized to improve local control and complication rates in this challenging area. METHODS Nine patients in this prospective series were treated with neoadjuvant chemoradiation (30 mg IV doxorubicin x 3d followed by 300 cGy/d x 10d) followed by surgery and two patients received radiation (5,000 cGy with tissue spacer) followed by surgery for tumors with a pelvic/retroperitoneal component. Surgery included resection plus reconstruction of the abdominal wall, myocutaneous flaps for large defects, and vascular reconstruction as necessary. RESULTS The 11 consecutive patients presented with Stage I (30%), II (40%), or III (30%) disease. Four patients (36%) were operated on for possible incarcerated hernia prior to referral and two (18%) presented with recurrent tumors. Pathology included 10 sarcomas and 1 desmoid tumor; tumor grade was low (30%), moderate (40%), or high (30%). Local control (mean follow-up 55 months; minimum follow-up 36 months) and limb salvage rate was 100%. Minor wound complications not requiring re-operation occurred in three patients, lymphedema in two, and there were no postoperative hernias. CONCLUSIONS Preoperative therapy provides excellent local control of groin soft tissue tumors. Current surgical techniques allow extensive resection with limb salvage, dependable primary wound healing and long-term integrity of the abdominal wall.
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Affiliation(s)
- L A Mack
- Department of Surgery/Oncology, University of Calgary, Calgary, Alberta, Canada
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Coleman J, Brennan MF, Alektiar K, Russo P. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol 2003; 10:669-75. [PMID: 12839852 DOI: 10.1245/aso.2003.11.014] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We present a 20-year surgical experience with spermatic cord sarcoma, describe prognostic features, and evaluate the results of surgical and adjunctive treatments. METHODS Forty-seven patients were identified from an institutional database. Disease-free survival was calculated, and prognostic factors such as tumor grade, size, extent of operation, and adjuvant therapy were analyzed. RESULTS The median patient age was 58 years (range, 16-83 years), and the median follow-up was 51 months (range,.5-226 months). The most common tumor types included liposarcoma (51%), leiomyosarcoma (19%), embryonal rhabdomyosarcoma (13%), and malignant fibrous histiocytoma (11%). Twenty-nine (62%) patients had high-grade tumors, 21 (45%) were treated with adjuvant radiation, and 9 (19%) received chemotherapy. The overall 5- and 10-year disease-specific survival was 75% and 55%, respectively. No specific prognostic factors were identified for recurrence or disease-free survival. In 21 patients who underwent reoperative wide resection after a prior incomplete resection, a trend toward improved disease-free survival was noted (P <.059). Of these, six (29%) had residual viable sarcoma. We could not demonstrate a therapeutic effect of adjuvant radiation or chemotherapy. CONCLUSIONS We demonstrated that aggressive surgical strategies, including reoperative wide resection, significantly decrease local recurrence and may improve disease free-survival in select patients with spermatic cord sarcoma.
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Affiliation(s)
- Jonathan Coleman
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Peyrí Rey E, Urban Ramón A, Martínez Fernández M, Sanmarti Da Silva B. [Dedifferentiated liposarcoma of spermatic cord: degeneration of lipoma previously resected]. Actas Urol Esp 2003; 27:383-6. [PMID: 12891917 DOI: 10.1016/s0210-4806(03)72940-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spermatic cord sarcomas are rare tumours. Dedifferentiated liposarcoma accounts for only 10% of all spermatic cord sarcomas. These are usually large-sized tumours histologically characterised for being well-differentiated liposarcomas with some high grade sarcoma areas. Volume, location, mass homogeneity as well as presence of pelvic and retroperitoneal adenopathies are reported by CT and ultrasound techniques. These are useful for post-treatment follow-up. This paper presents one spermatic cord, dedifferentiated liposarcoma from which lipomas from the same spermatic cord had been previously removed in three occasions. We believe this is a degeneration of the earlier resected lipoma. Management is by extended inguinal radical orchiectomy. Value of adjuvant radio- and chemotherapy is uncertain. Post-surgery local relapses are common, and haematogenous and pelvic nodes metastasis likely. Survival at 5 and 10 years is 75% and 63% respectively.
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Affiliation(s)
- E Peyrí Rey
- Servicio de Urología, Hospital Comarcal de la Selva., Blanes, Girona
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