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Di Pilla MA, Capuano MA, Rossi M, Di Pilla G, Minelli R, Pizzicato P, Rossi A, Paviglianiti G, Irace D, Vallone G, Salvia AA, Smaldone MC, Cariello V, Zeccolini R, Rossi E. Liposarcoma of the spermatic cord: The state of art and our experience. Radiol Case Rep 2023; 18:3941-3944. [PMID: 37680656 PMCID: PMC10480435 DOI: 10.1016/j.radcr.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Liposarcoma of the spermatic cord is a malignant neoformation so rare that less than 200 cases are reported in the world. It is a tumor that originates from adipose tissue and when it is found in the spermatic cord it can deceptively simulate an inguinal hernia and not be easily identified. The present work describes the case of a 37-year-old man with liposarcoma of the spermatic cord who arrives at our institution with painless swelling of the left testicle. Physical examination revealed a painless swelling in the scrotal sac. The scrotal ultrasound examination revealed a mass, measuring 8 cm (cranio-caudal) × 5.4 cm (latero-lateral) × 8 cm (antero-posterior) and characterized later with a basal CT examination of the abdomen. The patient was subsequently surgically treated with excision of the tumor, plus hernial plastic with plug and mesh. Histological examination revealed a mature adipocyte neoplasm whose morphological and molecular characteristics (amplification of the MDM2 gene) are consistent with the diagnosis of dediferrentiated liposarcoma variety CO-MINGLED, G2 (sec. FNCLCC). The patient is currently under cancer surveillance with no signs of loco-regional recurrence. Spermatic cord liposarcoma is an extremely rare malignancy. It's not easy to identify as it can simulate an inguinal hernia, hydrocele, lipoma, funicular cyst, or testicular tumor. Diagnosis is usually established postsurgery, however, relapses are common and the role of chemo-radiotherapy remains to be defined.
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Affiliation(s)
| | - Marco Alex Capuano
- Life and Health Department “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Mariangela Rossi
- Department of Radiodiagnostics “F. Veneziale”, Molise Regional HealthCompany (ASREM), Isernia, Italy
| | - Gianni Di Pilla
- Department of Radiodiagnostics “F. Veneziale”, Molise Regional HealthCompany (ASREM), Isernia, Italy
| | - Rocco Minelli
- Life and Health Department “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Paolo Pizzicato
- U.O.S.D. Diagnostic Imaging P.O. Pausilipon - AORN Santobono –Pausilipon, Naples, Italy
| | | | - Giuseppe Paviglianiti
- U.O.C. Pediatric Radiology PO G. Di Cristina-ARNAS Civico Benfratelli, Palermo, Italy
| | - Donatella Irace
- A.O.U. Federico II, Department of Translational Medical Sciences, Pediatric Section, Naples, Italy
| | - Gianfranco Vallone
- Life and Health Department “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Antonio A.H. Salvia
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Valentina Cariello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Zeccolini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Eugenio Rossi
- U.O.S.D. Diagnostic Imaging P.O. Pausilipon - AORN Santobono –Pausilipon, Naples, Italy
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Deacu M, Aschie M, Bosoteanu M, Vamesu S, Baltatescu GI, Cozaru GC, Orasanu CI, Voda RI. Rare paratesticular localization of dedifferentiated liposarcoma: Case report and review of the literature. Medicine (Baltimore) 2023; 102:e33265. [PMID: 36930135 PMCID: PMC10019146 DOI: 10.1097/md.0000000000033265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
RATIONALE Dedifferentiated liposarcoma is defined as a malignant tumor that changes its shape from a well-differentiated liposarcoma to a non-liposarcomatous form. Most paratesticular liposarcomas manifest as an inguinal, painless, slow-growing mass. The standard treatment is extensive surgical excision, radiotherapy being proposed for cases with positive margins, those with recurrence, or in cases of the existence of unfavorable prognostic factors. PATIENT CONCERNS We present the case of a young patient diagnosed initially with left hydrocele, which after 2 years proved to mask a differentiated liposarcoma of the spermatic cord. The initial clinical manifestations were represented by the increase in volume of the left groin-scrotal region and pain at this level. DIAGNOSIS Microscopic examination in hematoxylin-eosin staining highlighted the presence of lipoblasts and fibroblasts in association with areas of hemorrhage and tumor necrosis. The performed immunohistochemical tests confirmed the diagnosis of dedifferentiated liposarcoma. To support and confirm the presence of the mouse double minute 2 homolog gene mutation, chromogenic in situ hybridization analysis was performed. INTERVENTIONS The initial treatment was the surgical one. After 2 weeks, the patient received zolendronic acid for hypercalcemia which was caused by the osseous metastasis. OUTCOMES The patient died secondary to acute renal failure caused by hypercalcemia despite the treatment received. LESSONS This case underlines the importance of both the correct management of oncological patients, as well as immunohistochemical and genetic tests in the identification of prognostic factors, with the ultimate goal of administering an appropriate oncological treatment.
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Affiliation(s)
- Mariana Deacu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, Constanţa, Romania
| | - Mariana Aschie
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, Constanţa, Romania
- Academy of Medical Sciences of Romania, Bucharest, Romania
| | - Madalina Bosoteanu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanţa, Constanţa, Romania
| | - Sorin Vamesu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
| | - Gabriela-Izabela Baltatescu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanţa, Constanţa, Romania
| | - Georgeta Camelia Cozaru
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanţa, Constanţa, Romania
- Clinical Service of Pathology, Departments of Genetics, “Sf. Apostol Andrei” Emergency County Hospital, Constanta, Romania
| | - Cristian Ionut Orasanu
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanţa, Constanţa, Romania
| | - Raluca Ioana Voda
- Clinical Service of Pathology, Departments of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, Constanţa, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanţa, Constanţa, Romania
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Marzocchi G, Gentilini M, Cavini M, Lovato L. CT imaging of an unusual malignant inguinal mass: metastatic parafunicular dedifferentiated liposarcoma. BMJ Case Rep 2022; 15:e248332. [PMID: 35580951 PMCID: PMC9115031 DOI: 10.1136/bcr-2021-248332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 01/09/2023] Open
Abstract
A man in his 50s was redirected by his general practitioner to our University Hospital for a radiological evaluation after the complaint of a left inguinal swelling. The preliminary ultrasound and CT scan showed a left parafunicolar mass located between the root of the penis and the spermatic cord. The lesion was biopsied shortly after and histologically diagnosed as a dedifferentiated liposarcoma. The patient underwent a cycle of neoadjuvant radiotherapy, which proved to be ineffective. He was then subjected to an organ sparing surgical removal of the mass, followed by a second organ sparing removal of some residual disease. The last CT scan showed absence of the inguinal disease; however, lung and hepatic metastasis were detected, which are scheduled to be treated with a course of chemotherapy and radiofrequency.
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Affiliation(s)
- Guido Marzocchi
- Emergency Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Mattia Gentilini
- Department of Radiology, Ospedale Maurizio Bufalini, Bologna, Italy
| | - Marco Cavini
- Emergency Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
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