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Edo H, Yagi F, Mizuno M, Okada M, Hyoe E, Ozaki I, Akita H, Jinzaki M, Shinmoto H. Extratesticular masses focusing on MRI findings. Jpn J Radiol 2024:10.1007/s11604-024-01605-4. [PMID: 38836965 DOI: 10.1007/s11604-024-01605-4] [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: 04/01/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI.
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Affiliation(s)
- Hiromi Edo
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
| | - Fumiko Yagi
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mariko Mizuno
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Eiko Hyoe
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Ippei Ozaki
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
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Achard G, Charon-Barra C, Carrere S, Bonvalot S, Meeus P, Fau M, Honoré C, Delhorme JB, Tzanis D, Le Loarer F, Karanian-Philippe M, Ngo C, Le Guellec S, Bertaut A, Causeret S, Isambert N. Prognostic factors and outcomes of adult spermatic cord sarcoma. A study from the French Sarcoma Group. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1203-1208. [PMID: 36868941 DOI: 10.1016/j.ejso.2023.02.013] [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] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS). METHODS All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS). RESULTS A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1-2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3-90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6-74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR. CONCLUSIONS Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront.
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Affiliation(s)
- Gilles Achard
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Céline Charon-Barra
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sebastien Carrere
- Department of Surgery, Institut du Cancer de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France.
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Magali Fau
- Department of Surgery, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Jean-Baptiste Delhorme
- Department of Surgery, Centre Hospitalier Universitaire hautepierre, 1 Avenue Moliere, 67000, Strasbourg, France
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Marie Karanian-Philippe
- Department of Pathology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Carine Ngo
- Department of Pathology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Sophie Le Guellec
- Department of Pathology, Institut Universitaire de Cancer de Toulouse Oncopole, avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Aurélie Bertaut
- Department of Biostatistics, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
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Aksoy C, Karschuck P, Derigs M, Sevinc S, Groeben C, Zacharis A, Flegar L, Pehl A, Huber J, Mandal S. Successful management of 30 kg Gigantic para-testicular liposarcoma. BMC Urol 2023; 23:92. [PMID: 37170356 PMCID: PMC10176928 DOI: 10.1186/s12894-023-01236-3] [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: 12/30/2022] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular "giant" mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising.
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Affiliation(s)
- Cem Aksoy
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany.
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Marcus Derigs
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Selim Sevinc
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Aristeidis Zacharis
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Anika Pehl
- Department of Pathology, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
| | - Subhajit Mandal
- Department of Urology, Philipps-University Marburg, Baldingerstr, 35043, Marburg, Germany
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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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Liu Y, Zhang Z, Wang J, Wang S. Effects of radiotherapy on the survival of patients with malignant spermatic cord tumors: A retrospective cohort study. Cancer Med 2023; 12:5580-5589. [PMID: 36354142 PMCID: PMC10028065 DOI: 10.1002/cam4.5402] [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: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Malignant spermatic cord tumors (SCT) are rare and currently, there is no consensus regarding the role of radiotherapy in their treatment. This study evaluated the effect of radiotherapy on the overall survival (OS) of patients with malignant SCT based on the large-sample advantage of the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with malignant SCT recorded in the SEER database from 1975 to 2016 were included. All patients were divided into non-radiation and radiation groups, and propensity score matching (PSM) (1:1) was performed for baseline covariates between the two groups. The overall survival rate between the two groups of patients was analyzed using the Kaplan-Meier curve. The effects of radiotherapy on patient prognosis were analyzed using univariate and multivariate COX regression analyses. RESULTS In total, 389 patients with malignant SCT were included. There were 285 (73.26%) and 104 (26.74%) patients who either did or did not receive radiotherapy, respectively. Kaplan-Meier curves before and after PSM showed no significant differences in OS between the two groups. Similarly, multivariate COX regression models before and after PSM showed that radiotherapy was not an independent risk factor for OS in patients with malignant SCT. CONCLUSIONS Radiotherapy has no obvious advantage in improving the survival time of patients with malignant SCT.
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Affiliation(s)
- Yifu Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhicheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinxiang Wang
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Siyuan Wang
- Department of Urology, Sichuan Cancer Hospital, Chengdu, China
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Caviglia A, Beverini M, Pacchetti A, Branger N, Pignot G, Bertucci F, Walz J. A Giant Paratesticular Liposarcoma: Case Report and Literature Review. Case Rep Oncol 2023; 16:162-166. [PMID: 36970715 PMCID: PMC10035545 DOI: 10.1159/000528221] [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: 08/22/2022] [Accepted: 11/02/2022] [Indexed: 03/25/2023] Open
Abstract
Liposarcoma of the spermatic cord (LSC) is a very rare disease. In literature, are reported less than 350 cases. Genitourinary sarcomas account for <5% of all soft-tissue sarcomas and <2% of malignant urologic tumours. An inguinal mass is the clinical presentation, which can mimic a hernia or hydrocele. Since it is such a rare disease, there are insufficient data on chemotherapy and radiotherapy, and in any case, the data come from low-level scientific evidence. Here, we report the case of a patient who came to the observation for a giant inguinal mass, in which a definitive diagnosis was obtained with the histological examination.
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Affiliation(s)
- Alberto Caviglia
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Beverini
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, UMC+, Maastricht, The Netherlands
| | | | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Geraldine Pignot
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | | | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
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7
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Chan K, Odubanjo T, Swamy R, Hosny M. Giant Paratesticular Liposarcoma Mimicking a Left-Sided Groin Hernia: A Case Report. Cureus 2022; 14:e28856. [PMID: 36225510 PMCID: PMC9536849 DOI: 10.7759/cureus.28856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Giant paratesticular liposarcoma (PLS) is an uncommon tumour, often misdiagnosed pre-operatively, which presents as a painless scrotal mass. Early detection and prompt surgical management provide the best outcome. We present an 87-year-old patient with gradually enlarging, painless left scrotal swelling. Ultrasound on initial presentation suggested a benign hernia, resulting in an 11-month treatment delay. Computed tomography (CT) thereafter showed paratesticular scrotal mass measuring 14 x 8 x 7cm. Radical inguinal orchidectomy with high ligation of the spermatic cord was performed. Histopathology and cytogenetics confirmed PLS with both de-differentiated and well-differentiated features involving the spermatic cord margin. The patient had rapid progression to fatal lung metastasis within three months of surgery. Our case highlights that any suspicious fat swelling should be investigated thoroughly and excised promptly if paratesticular liposarcoma is suspected, as delayed management gives poor outcomes.
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8
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Pikramenos K, Katsimperis S, Zachou M, Giannakakou M, Mitsogianni M, Mitsogiannis I. Liposarcoma of the Spermatic Cord Mimicking an Inguinal Hernia: A Case Report and Literature Review. Cureus 2022; 14:e28269. [PMID: 36158429 PMCID: PMC9491821 DOI: 10.7759/cureus.28269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
Liposarcomas of the spermatic cord are extremely rare, with less than 200 cases in the literature. We present a case of sclerosing mixed with myxoid liposarcoma of the left spermatic cord in a 55-year-old male patient, mimicking an inguinal hernia on pre-operative ultrasound. The patient underwent orchidectomy and is currently on follow-up surveillance with no signs of recurrence.
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9
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Ahmed F, Aslam A, Tanveer Y, Jaffry S. Leiomyosarcoma of the spermatic cord: a rare paratesticular neoplasm case report. World J Surg Oncol 2022; 20:94. [PMID: 35337334 PMCID: PMC8957147 DOI: 10.1186/s12957-022-02539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology. CASE PRESENTATION A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment. CONCLUSION Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.
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Affiliation(s)
- Farah Ahmed
- Department of Urology, Letterkenny University Hospital, Letterkenny, Ireland.
| | - Asadullah Aslam
- Department of Urology, Letterkenny University Hospital, Letterkenny, Ireland
| | | | - Syed Jaffry
- Department of Urology, Galway University Hospital, Galway, Ireland
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10
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Kamitani R, Matsumoto K, Takeda T, Mizuno R, Oya M. Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases. BMC Cancer 2022; 22:15. [PMID: 34980039 PMCID: PMC8722180 DOI: 10.1186/s12885-021-09122-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Paratesticular leiomyosarcoma (LMS) is a rare tumor. Conventionally, tumor resection by high inguinal orchiectomy is performed as the preferred treatment approach for paratesticular sarcoma. On the other hand, testis-sparing surgery has recently attracted attention as a less-invasive treatment option for paratesticular sarcoma. However, the prognostic predictors and optimal treatment strategy for paratesticular LMS remain unclear because of its rarity. In this study, we systematically reviewed previously reported cases of paratesticular LMS to evaluate the prognostic factors and establish the optimal treatment strategy. METHODS A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular LMS published between 1971 and 2020 in English. The final cohort included 217 patients in 167 articles. The starting point of this study was the time of definitive surgical treatment, and the end point was the time of local recurrence (LR), distant metastasis (DM), and disease-specific mortality. RESULTS Patients with cutaneous LMS had a slightly better LR-free survival, DM-free survival, and disease-specific survival than those with subcutaneous LMS (p = 0.745, p = 0.033, and p = 0.126, respectively). Patients with higher grade tumors had a significantly higher risk of DM and disease-specific mortality (Grade 3 vs Grade 1 p < 0.001, and Grade 3 vs Grade 1 p < 0.001, respectively). In addition, those with a microscopic positive margin had a significantly higher risk of LR and DM than those with a negative margin (p < 0.001, and p = 0.018, respectively). Patients who underwent simple tumorectomy had a slightly higher risk of LR than those who underwent high inguinal orchiectomy (p = 0.067). Subgroup analysis of cutaneous LMS demonstrated that the difference in LR between simple tumorectomy and high inguinal orchiectomy was limited (p = 0.212). On the other hand, subgroup analysis of subcutaneous LMS revealed a significant difference in LR (p = 0.039). CONCLUSIONS Our study demonstrated that subcutaneous LMS and high-grade tumors are prognostic factors for paratesticular LMS. For subcutaneous LMS, tumorectomy with high inguinal orchiectomy should be the optimal treatment strategy to achieve a negative surgical margin.
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Affiliation(s)
- Rei Kamitani
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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11
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Ogbue OD, Haddad A, Daw H. Spermatic Cord Liposarcoma: A Case Report and Review of the Literature on the Role of Radiotherapy and Chemotherapy in Preventing Locoregional Recurrence. Cureus 2021; 13:e19567. [PMID: 34917443 PMCID: PMC8670550 DOI: 10.7759/cureus.19567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 11/23/2022] Open
Abstract
Spermatic cord cancer is a rare entity. Among malignant tumors of the spermatic cord, liposarcomas are the most common type, often presenting as painless slow-growing masses usually in the fifth and sixth decades of life; they can be misdiagnosed as inguinal hernia or hydrocele. Radical orchiectomy with wide local soft tissue resection is an accepted standard of care for spermatic cord liposarcoma and has been curative in some cases. There is no definitive role for other treatment modalities such as chemotherapy, retroperitoneal lymph node dissection (RPLND), and radiotherapy. We present a case of liposarcoma of the spermatic cord managed with radical orchiectomy, wide local excision, and was followed up without disease recurrence. We also engage in a review of the literature on the role of systemic chemotherapy and radiotherapy in preventing locoregional recurrence after primary surgery. A combination of surgery and postoperative radiotherapy is effective in preventing locoregional spread. Data from case reports support this strategy in certain histologic subtypes or when margins are positive after primary surgery. A follow-up period of up to a decade after surgery is recommended.
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Affiliation(s)
| | - Abdo Haddad
- Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | - Hamed Daw
- Hematology and Oncology, Cleveland Clinic Fairview Hospital, Cleveland, USA
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12
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Gupta A, Kulshrestha R, Kishore K, Micke O, Kumar R, Garg K, Sharma D, Pandey R. Identifying Patterns of Failure and Risk Factors for Recurrence in Patients of Paratesticular Sarcomas: Protocol of a Systematic Review and Meta-Analysis. Int J Surg Protoc 2021; 25:84-91. [PMID: 34113745 PMCID: PMC8162288 DOI: 10.29337/ijsp.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Para testicular sarcomas are rare mesenchymal tumors that affect patients of all ages. Unlike other sites of sarcoma, they tend to be of lower grade and have a higher propensity for lymphatic spread. Management is hampered by the small number of patients who differ in terms of tumor grade and histology. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. The consensus on the type of surgery and adjuvant treatment is yet to be determined. The local relapse rates in the scrotum and groin after orchidectomy comes out to be 25%–37%, indicating the need for either aggressive surgery or adjuvant treatment. There is a paucity of data identifying the patterns of failure and risk factors for recurrence, which will help clinicians tailor appropriate treatment. Methods: We aim to perform a systematic review and meta-analysis of the available data in the last 50 years in a methodologically rigorous and transparent manner to identify patterns of failure and high-risk factors for recurrence. The protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P) 2015 guidelines. The protocol is registered in the International Prospective Register of Systematic Reviews (CRD42021237134). Highlights Para testicular sarcomas are rare mesenchymal tumors that affects patients of all ages. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. A systemic review was performed in 2013 based on survival rates, prognostic factors, and relapse sites on paratesticular sarcomas. However, it lacks a comprehensive review that can guide radiation oncologists to select in which patient’s postoperative radiotherapy is warranted and define the target volume based on histopathological type, stage, and grade of the tumor. After 2013, new case series with improved methodology and sample size are published, which adds new information to the literature. In one case series, 22 patients with spermatic cord sarcoma were discussed, while in another study, long-term outcome analysis of 51 patients was discussed, and another study discussed eight patients.
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Affiliation(s)
- Anil Gupta
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
| | - Rashi Kulshrestha
- Clinical Radiation Oncology fellowship program, Department of Radiation Oncology, BC Cancer Agency, Abbotsford, BC, CA
| | - Kamal Kishore
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
| | - Oliver Micke
- Prof. Dr. med, Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Kiskerstrasse, Bielefeld, DE
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, IN
| | - Kanika Garg
- Department of Anaesthesiology, Employee's State Insurance Corporation, Noida, IN
| | - Dayanand Sharma
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi & National Cancer Institute, Jhajjar, Haryana, IN
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
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13
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Demirel HC, Tokuç E, Eryilmaz OT, Aykanli E, Yavuzsan AH, Ozagari AA, Kirecci SL, Horasanli K. The fate of paratesticular masses: 13 years' experience in a tertiary referral centre. Aktuelle Urol 2021. [PMID: 33853159 DOI: 10.1055/a-1345-6808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues. METHODOLOGY We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates. RESULTS A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions. CONCLUSION Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.
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Affiliation(s)
| | - Emre Tokuç
- Istanbul Sultanbeyli State Hospital, Urology, Istanbul, Turkey
| | - Ozlem Ton Eryilmaz
- Şişli Hamidiye Etfal Training and Research Hospital, Pathology, Şişli, Turkey
| | - Emre Aykanli
- Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey
| | | | - Ayse Aysim Ozagari
- Şişli Hamidiye Etfal Training and Research Hospital, Pathology, Şişli, Turkey
| | | | - Kaya Horasanli
- Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey
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14
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Testicular, Spermatic Cord, and Scrotal Soft Tissue Sarcomas: Treatment Outcomes and Patterns of Failure. Sarcoma 2021; 2021:8824301. [PMID: 33746565 PMCID: PMC7954631 DOI: 10.1155/2021/8824301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Paratesticular sarcomas are defined as tumors that arise within the scrotum and include the subsites of epididymis, spermatic cord, and tunica vaginalis and represent the most common type of GU sarcoma. The mainstay of treatment is often surgical resection, combined with histology specific chemotherapy and radiotherapy. Due to the rare nature of the disease, there are limited data to guide management. We present our single-institution retrospective experience regarding the management and treatment of paratesticular sarcomas. Materials and Methods We queried our oncology registry database for patients treated for testicular, spermatic cord, and scrotal soft tissue sarcomas between 1971 and 2017. Patients in this series had pathological confirmation of a sarcoma diagnosis by a sarcoma-specialized pathologist. Only patients with localized disease were included in this analysis with the exception of patients with a diagnosis of rhabdomyosarcoma where patients with both localized and metastatic disease were included on this study. Results A total of 34 patients were included in this retrospective analysis. The median was 24 (range, 5–78), and the median tumor size was 6.25 cm. Twenty-six patients had localized disease (76.6%) at the time of diagnosis. A predominance of patients had tumors involving the spermatic cord (45.5%), and the most common histology was rhabdomyosarcoma (35.3%), leiomyosarcoma (26.5%), and well-differentiated liposarcoma (23.5%). The median follow-up was 71.0 months (range, 2.5–534.4 months). A total of 7 patients experienced an isolated local failure (20.6%), four patients developed distant metastatic disease (11.8%), and one patient (2.9%) with synovial sarcoma of the spermatic cord experienced a regional recurrence. The median progression-free survival (PFS) was 99.6 months, 95% CI (45.8–534.3 months), with a three-year PFS rate of 71%, 95% CI (53%–83%), and a 5-year PFS rate of 64% (range, 46%–78%). We did not find any statistically significant associations based on surgery type (p=0.15), the use of chemotherapy, (p=0.36), or final margin status (p=0.21). Two patients who were treated with preoperative radiotherapy had significant wound healing complication with chronic sinus tracts, though these patients did not experience a local recurrence. Conclusions We provide a characterization of the natural history and treatment patterns of paratesticular sarcomas. While effective at reducing a local recurrence, preoperative radiotherapy was associated with significant toxicity. As a result, we prefer the use of postoperative radiotherapy in patients as clinically indicated. We did not find any specific treatment patterns associated with an improvement in clinical outcomes.
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15
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Zeng J, Pollock G, Addams J, Bracamonte E, Chipollini J. Leiomyosarcoma of the scrotum: a case report and literature review. Transl Androl Urol 2021; 10:1342-1346. [PMID: 33850768 PMCID: PMC8039593 DOI: 10.21037/tau-20-1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Grant Pollock
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Addams
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Juan Chipollini
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
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16
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Jeremić D, Maletin M, Vojinov S, Levakov I, Grbić D, Lakić T, Trivunić Dajko S. LIPOSARCOMA OF THE SPERMATIC CORD - DIAGNOSTIC AND THERAPEUTIC ISSUE. Acta Clin Croat 2021; 60:50-54. [PMID: 34588721 PMCID: PMC8305359 DOI: 10.20471/acc.2021.60.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/24/2020] [Indexed: 01/09/2023] Open
Abstract
Liposarcoma of the spermatic cord is a malignant tumor so rare that there are less than 200 cases reported in the literature worldwide. Liposarcoma is a malignancy which originates from fat tissue. Although only 3%-7% of all paratesticular sarcomas primarily arise from structures of the spermatic cord, clinical significance of these tumors must not be neglected because they are often preoperatively misdiagnosed. A 66-year-old male presented with a painless swelling on the left side of the scrotum. Local examination revealed a solid, smooth, limited mass of approximately 4x3 cm in the left side of the scrotum. Tumor markers were within the reference range. Ultrasound examination showed a solid, clearly limited non-homogeneous mass of 40x20 mm localized in the left spermatic cord. Magnetic resonance imaging showed an expansive mass measuring 60x85x60 mm in the left inguinoscrotal region without propagation into the abdominal cavity. Both testicles and epididymides appeared normal on magnetic resonance examination and no locoregional enlarged lymph nodes were seen. The patient was treated operatively with radical inguinal orchiectomy. In conclusion, liposarcomas of the spermatic cord are extremely rare neoplasms that clinically present as slow-growing, painless, palpable inguinal or scrotal masses. Radical orchiectomy with high ligation of the spermatic cord and wide excision of the surrounding soft tissues within the inguinal canal remains the gold standard treatment option. Recurrence of the disease is frequent even several years after primary therapy, therefore long-term follow-up is mandatory.
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Affiliation(s)
| | - Miloš Maletin
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Saša Vojinov
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Ivan Levakov
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Dragan Grbić
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Tanja Lakić
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Sandra Trivunić Dajko
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
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17
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Pereira KP, Rodrigues M, Roda D, Alves P. Adjuvant radiotherapy in the treatment of dedifferentiated liposarcoma of the spermatic cord: a rare entity. BMJ Case Rep 2021; 14:e238430. [PMID: 33419753 PMCID: PMC7798654 DOI: 10.1136/bcr-2020-238430] [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: 12/11/2020] [Indexed: 01/11/2023] Open
Abstract
Dedifferentiated liposarcoma (DDL) of the spermatic cord is a very rare entity in which management is remarkably controversial due to scarce literature. Although the actual standard of care is surgery via radical inguinal orchiectomy, adjuvant therapies like radiotherapy have demonstrated improved local control, particularly in cases with higher risk for local recurrence and worse prognosis. The role of adjuvant chemotherapy remains questionable in this subset of patients. On literature review, the most important prognostic factors for survival outcomes were surgical margin status, histological grade and the presence of metastases prior to the initial surgery. In this report, we discuss the case of a 59-year-old man with DDL of the spermatic cord that was treated with surgery followed by adjuvant radiotherapy. We also provide a comprehensive literature review about the management of this entity.
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Affiliation(s)
- Kayla Pires Pereira
- Radiotherapy Department, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | - Mónica Rodrigues
- Radiotherapy Department, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | - Domingos Roda
- Radiotherapy Department, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | - Paula Alves
- Radiotherapy Department, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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18
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Iafrate M, Motterle G, Zaborra C, Leone N, Prayer-Galetti T, Zattoni F, Guttilla A, Cappellesso R, Dei Tos AP, Rossi CR, Del Fiore P, Rastrelli M, Mocellin S. Spermatic Cord Sarcoma: A 20-Year Single-Institution Experience. Front Surg 2020; 7:566408. [PMID: 33282904 PMCID: PMC7705095 DOI: 10.3389/fsurg.2020.566408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Spermatic cord sarcomas represent a rare genitourinary malignancy with a challenging diagnostic and therapeutic pathway. Different histotypes have been described and prognostic factors remain poorly defined due to the paucity of data presented in literature. Methods: Retrospective chart review of 22 adult patients treated for spermatic cord sarcoma in a single institution in the last 20 years was performed. Clinicopathological characteristics of the tumors were collected with primary and subsequent treatment. Survival analysis was performed in order to identify prognostic factors of disease-specific survival. Results: The median age at diagnosis was 68 years (58–78), the most common histotype was liposarcoma (14/22), and most patients (63.6%) were found to have positive surgical margins after surgery. The 5-year cancer specific survival was 91.3%. Grading (p = 0.480), histotype (p = 0.327), and type of intervention (p = 0.732) were not associated with survival. All patients dead of disease had positive surgical margins (p = 0.172). Conclusion: We report a good prognosis at 5 years. Wide radical resection remains the first and probably the most important step; thus, according also to literature, negative surgical margins should be aimed.
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Affiliation(s)
- Massimo Iafrate
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Giovanni Motterle
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Carlotta Zaborra
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Niccolò Leone
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Tommaso Prayer-Galetti
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Filiberto Zattoni
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Andrea Guttilla
- Clinica Urologica dell'Ospedale di Camposampiero, Camposampiero, Italy
| | - Rocco Cappellesso
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Marco Rastrelli
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Simone Mocellin
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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19
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Optimal treatment strategy for paratesticular liposarcoma: retrospective analysis of 265 reported cases. Int J Clin Oncol 2020; 25:2099-2106. [PMID: 32715355 DOI: 10.1007/s10147-020-01753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Liposarcoma is one of the most common subtypes of soft tissue sarcoma. Although the standard treatment for localized liposarcoma is surgical resection with negative margins, a treatment specific to paratesticular liposarcoma has yet to be quantitatively evaluated. METHODS A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular liposarcoma published between 1979 and 2018 in English. The final cohort included 265 patients in 183 articles. The starting point was the time of surgical treatment, and the endpoint was the time of recurrence, including local recurrence, or distant metastasis. RESULTS The median patient age was 62 years and the median tumor size was 9.5 cm. In total, 178 patients underwent high inguinal orchiectomy and 40 underwent simple tumorectomy. Based on the Kaplan-Meier curves, recurrence-free survival rates were significantly higher for those who underwent high inguinal orchiectomy than for those who underwent tumorectomy. Moreover, those with microscopic positive margins had a higher risk of recurrence than those with negative margins, but adjuvant radiation therapy after resection had no statistically significant effect on recurrence-free survival, even in subgroup analysis of patients with positive margins. Regarding the pathological subtypes, dedifferentiated, pleomorphic, and round-cell liposarcoma had a higher risk of recurrence than well-differentiated or myxoid liposarcoma. In the multivariate analysis, high inguinal orchiectomy greatly affected recurrence-free survival. The tumor size and histological subtype were independent risk factors for recurrence. CONCLUSION Complete resection with high inguinal orchiectomy is the optimal treatment for paratesticular liposarcoma.
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20
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Gatto L, Del Gaudio M, Ravaioli M, Cescon M, Tonini V, Cervellera M, Franceschelli A, Pirini MG, Di Scioscio V, Buia F, Niro F, Capizzi E, Fiorentino M, Astolfi A, Indio V, Nannini M, Pantaleo MA, Saponara M. Paratesticular Mesenchymal Malignancies: A Single-Center Case Series, Clinical Management, and Review of Literature. Integr Cancer Ther 2020; 19:1534735419900554. [PMID: 32009477 PMCID: PMC7050957 DOI: 10.1177/1534735419900554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Primary soft tissue sarcomas arising from the male urinary and genital tract are rare tumors, only accounting for 1% to 2% of all malignancies of the genitourinary tract. Clinical management of advanced disease is lacking in standardized recommendations due to the rarity of the disease. To date, complete and extensive surgery represents the only curative and standardized approach for localized disease, while the impact of retroperitoneal lymphadenectomy and adjuvant treatments on clinical outcomes are still unclear. Similarly, a standardized systemic treatment for advanced metastatic disease is still missing. Cases Presentation: Four out of 274 patients have been identified in our sarcoma population. The mean age was 54 years (range = 45-73). The histotypes showed liposarcoma in 2 cases and leiomyosarcoma in the remaining 2 cases. In all 4 cases, the disease was localized at presentation, patients underwent complete surgery, and no adjuvant treatments were done. Three cases presented a recurrence of disease at a mean follow-up of 86 months (range = 60-106 months), more than 7 years. Two cases were treated with a second surgery and chemotherapy and 1 case only with chemotherapy. Discussion and Conclusions: Sharing data about clinical management of paratesticular mesenchymal tumors is a key issue due to the rarity of this tumor's subtype. In this article, we report the clinical history of 4 patients affected by paratesticular mesenchymal tumor. In particular, main issues of interest are the decision of postoperative treatment and systemic treatment at time of disease recurrence.
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Affiliation(s)
- Lidia Gatto
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Massimo Del Gaudio
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Matteo Ravaioli
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Valeria Tonini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Maurizio Cervellera
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Maria Giulia Pirini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Valerio Di Scioscio
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Francesco Buia
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Fabio Niro
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Elisa Capizzi
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | | | | | - Margherita Nannini
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Maristella Saponara
- Sant'Orsola-Malpighi Hospital, Bologna, Italy.,University of Bologna, Bologna, Italy
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21
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A Paratesticular Angiolipoma: A Case Report of a Rare Benign Scrotal Mass and Review of Literature. Case Rep Urol 2019; 2019:1478573. [PMID: 31321115 PMCID: PMC6609340 DOI: 10.1155/2019/1478573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of paratesticular angiolipoma in a young male. The patient is a 21-year-old male who presented with a palpable firm right intrascrotal mass of 21 mm. Ultrasound findings demonstrated that it is a solid mass. Under the diagnosis of an intrascrotal solid mass, a right inguinal radical orchiectomy was performed. Histopathological examination concluded to a paratesticular angiolipoma. Angiolipoma is a rare benign form of paratesticular tumour and its diagnosis is based on histological findings of the surgical specimen with no recurrence risk. This mesenchymal tumour should be distinguished from liposarcoma, which has malignant or aggressive clinical course.
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22
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Goldberg H, Wong LM, Dickson B, Catton C, Yap SA, Alkasab T, Evans A, van der Kwast T, Jewett MAS, Hamilton RJ. Long-term oncological outcomes of patients with paratesticular sarcoma. BJU Int 2019; 124:801-810. [DOI: 10.1111/bju.14775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hanan Goldberg
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Lih-Ming Wong
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Surgery; St. Vincent's Hospital Melbourne; University of Melbourne; Parkville Victoria Australia
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital, New York, NY, USA, and University of Toronto; Toronto ON Canada
| | - Charles Catton
- Department of Radiation Oncology; Princess Margaret Cancer Center; University Health Network; University of Toronto; Toronto ON Canada
| | - Stanley A. Yap
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Urology; University of California Davis; Sacramento CA USA
| | - Thamir Alkasab
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Andrew Evans
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Theodorus van der Kwast
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Michael A. S. Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Robert J. Hamilton
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
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Moussa M, Abou Chakra M. Leiomyosarcoma of the spermatic cord: A case report and literature review. Int J Surg Case Rep 2019; 57:175-178. [PMID: 30981071 PMCID: PMC6461569 DOI: 10.1016/j.ijscr.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022] Open
Abstract
Leiomyosarcoma of the spermatic cord is a rare entity. The diagnosis of spermatic cord leiomyosarcoma is difficult based on imagery alone. The standard treatment is radical orchidectomy with high ligation of the spermatic cord.
Background Leiomyosarcoma of the spermatic cord is a rare entity. It presents as a firm and painless intrascrotal mass. For diagnosis radiological methods such as ultrasound, CT or MRI are necessary. Radical orchiectomy is the gold standard of treatment. Case description We reported a one case of a 66-year-old man that he has suffered from a painless hard mass in the right hemiscrotum since three years. Ultrasound revealed a paratesticular mass. Further workup revealed no distant metastasis before surgery. Right radical orchiectomy was performed, the final pathologic examination showed a leiomyosarcoma of the spermatic cord. The patient remained disease-free twelve-month during follow up after surgery. Discussion Leiomyosarcoma of the spermatic cord is a rare condition, it arises from mesenchymal cells of the spermatic cord and occurs mainly in elderly patients. The diagnosis of spermatic cord leiomyosarcoma is difficult if based only on imaging procedures, it is revealed by histological examination post surgery. No treatment protocol has yet been established for paratesticular leiomyosarcoma due to the rarity of the disease. Standard treatment is radical orchidectomy with high ligation of the spermatic cord. The benefit of adjuvant chemotherapy, radiotherapy, and retroperitoneal lymphadenectomy are not well understood and may differ according to the surgeon's preferences. Conclusion The lack of such cases results in the challenging nature of the diagnosis and treatment of leiomyosarcoma of the spermatic cord. Additional studies are needed to better define optimal management strategies.
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Affiliation(s)
- Mohamad Moussa
- Head of Urology Department, Zahra University Hospital, Beirut, Lebanon.
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Keenan RA, Nic An Riogh AU, Stroiescu A, Fuentes A, Heneghan J, Cullen IM, Daly PJ. Paratesticular sarcomas: a case series and literature review. Ther Adv Urol 2019; 11:1756287218818029. [PMID: 30671140 PMCID: PMC6329018 DOI: 10.1177/1756287218818029] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 01/08/2023] Open
Abstract
Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings. Ultrasound in each case confirmed an extratesticular mass. Only the second gentleman complained of associated pain, however he had experienced scrotal trauma in the preceding weeks. Only one patient had suspicions of metastatic disease, with a 9 mm pulmonary nodule on computed tomography. All patients underwent a radical inguinal orchidectomy with high ligation of the spermatic cord, in keeping with best accepted guidelines. Histology confirmed a well-differentiated liposarcoma, a dedifferentiated liposarcoma and a leiomyosarcoma respectively, all high grade. One gentleman returned to theatre for re-excision of margins. Our case series emphasises the need for full multidisciplinary team specialist sarcoma input, as well as radical resection with judicious margins in order to reduce the risk of local recurrence, in the treatment of these rare tumours.
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Affiliation(s)
| | | | - Andrea Stroiescu
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - Adrian Fuentes
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Joan Heneghan
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Padraig J Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
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25
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Aoki K, Yamaguchi M, Sugiyama A, Inoue Y, Fukuda H, Gika M, Yamazaki M, Kawano R, Momose S, Nakayama M. Metastatic thymic tumor arising from spermatic cord leiomyosarcoma. Gen Thorac Cardiovasc Surg 2018; 67:490-492. [PMID: 30032446 DOI: 10.1007/s11748-018-0973-3] [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: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
We report the first known case of a metastatic thymic tumor arising from spermatic cord leiomyosarcoma, occurring in a 35-year-old man. He had undergone an orchiectomy 24 months previously and a surgical excision of a subcutaneous metastasis 4 months prior to his current presentation. Computed tomography revealed a 1.5-cm, round-shaped anterior mediastinal mass. A thymectomy was performed and the diagnosis of metastatic leiomyosarcoma was made.
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Affiliation(s)
- Kohei Aoki
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Masatoshi Yamaguchi
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Ato Sugiyama
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yoshiaki Inoue
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Hiroki Fukuda
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Masatoshi Gika
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Mami Yamazaki
- Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Ryutarou Kawano
- Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Shuji Momose
- Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Mitsuo Nakayama
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
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26
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Abstract
PURPOSE OF REVIEW Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT. RECENT FINDINGS Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available. SUMMARY SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.
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27
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Murray KS, Vertosick EA, Spaliviero M, Mashni JW, Sjoberg DD, Alektiar KM, Herr HW, Russo P, Coleman JA. Importance of wide re-resection in adult spermatic cord sarcomas: Report on oncologic outcomes at a single institution. J Surg Oncol 2018; 117:1464-1468. [PMID: 29473967 DOI: 10.1002/jso.25016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the effect of re-resection with wide margins (undertaken because initial resection performed elsewhere was incomplete) on survival in patients with spermatic cord sarcoma (SCS). METHODS After excluding those with metastatic disease and those not undergoing surgical intervention, the records of 72 consecutive patients treated for SCS between 1981 and 2011 at Memorial Sloan Kettering Cancer Center were reviewed. Recurrence-free survival (RFS) and cancer-specific survival were calculated using the Kaplan-Meier method for comparing between the 48 patients who underwent wide re-resection (WRR) within 5 months of diagnosis and the 24 who did not. The relationship of age, tumor size, tumor histology, adjuvant radiation, and wide re-resection with recurrence and death was assessed by univariate Cox regression. RESULTS WRR significantly improved RFS (hazard ratio [HR] 0.16, 95%CI 0.07-0.37; P < 0.0001), despite the fact that patients receiving WRR had higher-grade disease. Tumor-positive margins upon WRR were strongly associated with both disease recurrence (HR 5.56; 95%CI 1.14-27.11, P = 0.034) and death from cancer (HR 6.16, 95%CI 1.25-30.29; P = 0.025). CONCLUSIONS A WRR with negative margins is effective in the management of patients with SCS and leads to improved RFS.
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Affiliation(s)
- Katie S Murray
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Massimiliano Spaliviero
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Joseph W Mashni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Banner MD Anderson Cancer Center Clinic, Gilbert, Arizona
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaled M Alektiar
- Brachytherapy Service, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
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28
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Balducci M, Di Rito A, Mantini G, Manfrida S, Chiesa S, Frascino V, D'Agostino GR, Valentini V, De Bari B. Role of Radiotherapy in the Treatment of Fibrosarcoma of the Spermatic Cord: A Case Report and Review of the Literature. TUMORI JOURNAL 2018; 97:36e-8e. [DOI: 10.1177/030089161109700624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local resection, while the role of adjuvant therapies is not clear. We present a case of fibrosarcoma of the spermatic cord treated with surgery and adjuvant radiotherapy. A review of the literature about the role of adjuvant treatments is also discussed. Case Report A 59-year-old man presented a right testicular mass of about 4 × 3 cm in size. Biopsy showed a high-grade polymorphous sarcoma, consistent with a diagnosis of poorly differentiated fibromyosarcoma. He underwent a right radical inguinal orchiectomy and adjuvant radiotherapy (total dose: 5940 cGy). During treatment the patient developed a G3 skin toxicity (RTOG score) in the inguinal fold. After a follow-up of 57 months, he is alive and without evidence of local or distant recurrence. No late toxicity was noted. Conclusion The optimal adjuvant management of spermatic cord sarcoma is still uncertain. Looking at the literature, it seems that adjuvant radiotherapy can improve locoregional control and disease-free survival without additional late toxicity.
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Affiliation(s)
- Mario Balducci
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Alessia Di Rito
- Service de Radiothérapie, Centre Medical de Forcilles, Ferolles-Attilly, France
| | - Giovanna Mantini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Stefania Manfrida
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Vincenzo Frascino
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | | | - Vincenzo Valentini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Berardino De Bari
- Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon-Sud, Pierre Benite, France
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Thomas KL, Gonzalez RJ, Henderson-Jackson E, Caracciolo JT. Paratesticular Liposarcoma Masquerading as an Inguinal Hernia. Urology 2017; 113:e5-e6. [PMID: 29203187 DOI: 10.1016/j.urology.2017.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
A man with left scrotal swelling felt to represent inguinal hernia underwent computed tomography scan for reported bleeding after prostate biopsy. Computed tomography scan revealed a 15-cm extratesticular left scrotal mass containing both fat and soft tissue components, raising concern for dedifferentiated liposarcoma. At surgery and pathology, the mass was separate from the left testis, epididymis, and spermatic cord. Histopathologic findings were consistent with paratesticular dedifferentiated liposarcoma.
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Affiliation(s)
- Kerry L Thomas
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL.
| | - Ricardo J Gonzalez
- Department of Sarcoma and Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Jamie T Caracciolo
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL
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30
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Andersen MFB, Fode M, Pilt AP, Azawi NHM. Liposarcoma in the spermatic cord presenting as an inguinal swelling. Transl Androl Urol 2017; 6:978-980. [PMID: 29184799 PMCID: PMC5673813 DOI: 10.21037/tau.2017.08.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Liposarcoma in the spermatic cord is a rare condition with an incidence of 1 per 2.5 million. The condition can present as paratesticular pain and a quick diagnosis is important in order to ensure proper treatment and to improve the prognosis. We describe a case of a 69-year-old man who suffered from long-lasting swelling in the inguinal area and experienced increasing pain through a period of 2 weeks. Due to increasing pain and fast growing swelling, an exploration of the inguinal area was performed and peroperatively a tumour in the spermatic cord was found. Subsequent histological examination revealed a de-differentiated liposarcoma.
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Affiliation(s)
| | - Mikkel Fode
- Deptartment of Urology, Zealand's Hospital University Roskilde, Roskilde, Denmark
| | - Anette Pedersen Pilt
- Department of Pathology, Zealand's Hospital University Roskilde, Roskilde, Denmark
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31
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Ramanathan S, Palaniappan Y, Sheikh A, Ryan J, Kielar A. Crossing the canal: Looking beyond hernias — Spectrum of common, uncommon and atypical pathologies in the inguinal canal. Clin Imaging 2017; 42:7-18. [DOI: 10.1016/j.clinimag.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/25/2016] [Accepted: 11/04/2016] [Indexed: 01/09/2023]
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Chalouhy C, Ruck JM, Moukarzel M, Jourdi R, Dagher N, Philosophe B. Current management of liposarcoma of the spermatic cord: A case report and review of the literature. Mol Clin Oncol 2017; 6:438-440. [PMID: 28451429 DOI: 10.3892/mco.2017.1157] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/12/2016] [Indexed: 11/06/2022] Open
Abstract
Liposarcomas of the spermatic cord, a rare cause of an inguinal mass, may closely mimic inguinal hernias on clinical examination. However, these tumors require a different surgical approach and treatment plan; therefore, intraoperative diagnosis might complicate patient management. We report the case of a 63-year-old man who presented with a mobile mass in the inguinal canal consistent with an inguinal hernia. The patient was subsequently diagnosed with a liposarcoma of the spermatic cord and successfully treated with extensive local resection, including radical orchiectomy and en bloc resection of the mass and associated cord structures. No adjuvant therapy was deemed necessary, and the patient remained asymptomatic and disease-free 10 years after surgery. The details of this case are presented, along with a review and discussion of the currently available data regarding the diagnosis and management of this challenging condition.
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Affiliation(s)
- Charbel Chalouhy
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jessica M Ruck
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Maroun Moukarzel
- Department of Urology, Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - Roy Jourdi
- Department of Urology, Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - Nabil Dagher
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Gregorio MD, D'Hondt L, Lorge F, Nollevaux MC. Liposarcoma of the Spermatic Cord: An Infrequent Pathology. Case Rep Oncol 2017; 10:136-142. [PMID: 28203177 PMCID: PMC5301103 DOI: 10.1159/000455900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To describe a rare pathology, the liposarcoma of the spermatic cord (LSC), and discuss its diagnosis and treatment. Materials and Methods We report a case of well-differentiated LSC in a 61-year-old man. The main complaint was painless enlargement in the right inguinoscrotal area that appeared 6 months prior to presentation. Ultrasonography showed a heterogeneous and hyperechogenic mass of the right spermatic cord that was highly suspicious of malignancy. Computed tomography confirmed a heterogeneous supratesticular mass. The mass was surgically removed. Results Pathological examination showed a well-differentiated LSC. The patient did not receive any additional treatment. The follow-up did not present complications or further symptoms and, at present, the patient is in complete remission. Conclusion LCSs are a very rare entity. The diagnosis is difficult and often mistaken with common scrotal swelling associated with a hernia, hydrocele, or other tumour. Treatment should include complete surgical excision, usually by radical inguinal orchiectomy. A long follow-up period is necessary.
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Cerda T, Martin É, Truc G, Créhange G, Maingon P. Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma. Cancer Radiother 2016; 21:16-20. [PMID: 28041814 DOI: 10.1016/j.canrad.2016.07.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. PATIENTS AND METHODS Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery. RESULTS Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up. CONCLUSION No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
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Affiliation(s)
- T Cerda
- Department of Radiation Oncology, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Truc
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Créhange
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Medical Imaging group, laboratoire électronique, informatique et image (Le2I) UMR 6306, CNRS, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, Arts et Métiers, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, UFR Sciences et Techniques, université de Bourgogne-Franche-Comté, allée Alain-Savary, 21000 Dijon, France
| | - P Maingon
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
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Paratesticular Sarcoma: Typical Presentation, Imaging Features, and Clinical Challenges. Urology 2016; 100:163-168. [PMID: 27639792 DOI: 10.1016/j.urology.2016.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/29/2016] [Accepted: 09/03/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe the major imaging features, together with clinical data, of paratesticular sarcomas. MATERIALS AND METHODS A retrospective analysis was performed of available imaging and clinical data of 77 consecutive cases of paratesticular sarcoma referred to the soft tissue sarcoma center at the Royal Marsden hospital between January 2006 and January 2015. RESULTS Of the total cases, 87% had been referred postoperatively, 43% of which had been imaged preoperatively and 24% of which required re-resection due to incomplete initial excision. On imaging, abnormal fat was present in 73% of paratesticular liposarcomas, with solid or enhancing components indicating high-grade tumors. Leiomyosarcomas and rhabdomyosarcomas were all purely solid masses. CONCLUSION Paratesticular sarcomas are rare, and lack of awareness may compromise treatment and outcome. They may be mistaken for common clinical problems such as inguinal hernias and epididymal cysts. Surgery for these presumed diagnoses may result in inadequate clearance and an increased risk of recurrence. A low threshold for imaging atypical paratesticular masses is needed, as this may better inform management.
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36
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Sopeña-Sutil R, Silan F, Butron-Vila MT, Guerrero-Ramos F, Lagaron-Comba E, Passas-Martinez J. Multidisciplinary approach to giant paratesticular liposarcoma. Can Urol Assoc J 2016; 10:E316-E319. [PMID: 27695588 DOI: 10.5489/cuaj.3346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary paratesticular tumours are very rare and the spermatic cord (SCT) is the most frequent site of origin, with 20% of malignancy. Although liposarcoma is the most frequent histotype (46.6 %), less than 200 cases have been reported in the literature. We report the case of a 56-year-old man who presented a giant scrotal mass of 25 years of evolution and measuring 40 × 40 cm. It could be considered the greatest paratesticular liposarcoma described to date. Computed tomogaphy (CT) revealed mass features consistent with liposarcoma and the simultaneous presence of bilateral inguinal hernia with bladder involvement. A multidisciplinary approach was taken to remove the mass, solve the hernia, and provide functional results.
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Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention--An Institutional Experience. Int J Surg Oncol 2016; 2016:4785394. [PMID: 27190644 PMCID: PMC4848420 DOI: 10.1155/2016/4785394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/14/2016] [Accepted: 03/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation. Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined. Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%. Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins.
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Chan DKH, Durai P, Parameswaran R. Liposarcoma of the cord treated with surgery alone: Our experience of five patients. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815604064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Liposarcoma of the spermatic cord is a rare condition presenting as an inguinal or scrotal mass. We describe our experience in the management of five patients diagnosed with this disease. Methods: We conducted a retrospective analysis of patients who underwent treatment for the condition between 2011 and 2014. Demographic data collected included the patient’s age, presentation, site of tumour, tumour size and grade and World Health Organisation (WHO) histotypes. Adequacy of tumour resection and the use of adjuvant chemotherapy or radiotherapy were also recorded. The study end points included duration of disease-free survival (DFS) as well as overall survival (OS). Results: During the study period we identified five patients with a diagnosis of liposarcoma of the cord with a median age of 67 (range 33–72) years. Three patients presented with primary disease and two were diagnosed post-resection and required re-excision to obtain R0 resection margins. Three patients had well-differentiated and two patients had dedifferentiated liposarcoma. None of the patients required adjuvant chemotherapy or radiotherapy following achievement of R0 resection margins and developed loco-regional recurrence or distant metastases. Median DFS was 30 (range 10–45) months. Conclusion: Liposarcomas of the cord are rare soft-tissue sarcomas with a high incidence of recurrence. Treatment of choice is radical orchidectomy, wide excision of the tumour and high ligation of the spermatic cord. Long-term follow-up is necessary.
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Affiliation(s)
| | - Pradeep Durai
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Rajeev Parameswaran
- Department of Endocrine Surgery, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University Hospital, Singapore
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Cao MX, Chen J, Zhang JL, Wei X, Liang YY. Organ-sparing Surgery in Treating Patients with Liposarcoma of the Spermatic Cord: Institutional Experience and Pooled Analysis. Asian Pac J Cancer Prev 2016; 16:3419-23. [PMID: 25921155 DOI: 10.7314/apjcp.2015.16.8.3419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liposarcoma of the spermatic cord is rare and frequently misdiagnosed. The standard therapeutic approach has been radical inguinal orchiectomy with wide local resection of surrounding soft tissues. The current trend of organ preservation in the treatment of several cancers has started to evolve. Herein we present our testis-sparing surgery experience in the treatment of spermatic cord liposarcoma and a pooled analysis on this topic. MATERIALS AND METHODS Clinical information from patient receiving organ-sparing surgery was described. Clinical studies evaluating this issue were identified by using a predefined search strategy, e.g., Pubmed database with no restriction on date of published papers. The literature search used the following terms: epidemiology , surgery , chemotherapy , radiotherapy , testis sparing surgery, spermatic cord sarcomas/ liposarcomas. RESULTS Patient received a complete excision of the lesion, preserving the spermatic cord and the testis. The final pathological report showed a well differentiated liposarcoma with negative surgical margins and no signs of local invasion. After 2-year of follow-up, there was no evidence of local recurrence. Since the first case reported in 1952, a total of about 200 well-documented spermatic cord liposarcoma cases have been published in English literature. Among these patients, only three instances were reported to have received an organ-sparing surgery in the treatment of spermatic cord liposarcoma. CONCLUSIONS Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. But for small, especially well-differentiated, lesions, testis-sparing surgery might be a good option if an adequate negative surgical margin is assured.
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Affiliation(s)
- Ming-Xin Cao
- Department of Urology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China E-mail :
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Zolotareva EV, Andreeva YY, Frank GA, Rodionov VI. [Liposarcoma of the spermatic cord]. Arkh Patol 2015; 77:41-50. [PMID: 26226781 DOI: 10.17116/patol201577341-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper reviews the literature on primary paratesticular tumors. It describes the classification, brief characteristics of liposarcomas and the morphological pattern of the tumor with an immunohistochemical profile. A clinical case of differentiated liposarcoma of the spermatic cord with myxoid and rhabdomyoblastic differentiation is depicted in a 61-year-old man.
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Affiliation(s)
- E V Zolotareva
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - Yu Yu Andreeva
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - G A Frank
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - V I Rodionov
- Medical Center on the Botkinsky, OOO 'MRT Azbuka Zdorovia' (Health Alphabet MRI), Moscow
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Palomeque Jiménez A, Reyes Moreno M, Martín Cano J, Calzado Baeza S. Fibrohistiocitoma maligno del cordón espermático. UROLOGÍA COLOMBIANA 2015. [DOI: 10.1016/j.uroco.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patel B, Vora A, Muruve N. Case of Subcutaneous Leiomyosarcoma of the Scrotum Presenting as a Sebaceous Cyst in a 71-Year-old Man: A Case Report and Review of the Literature. Urol Case Rep 2014; 2:181-2. [PMID: 26958482 PMCID: PMC4782121 DOI: 10.1016/j.eucr.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/31/2014] [Indexed: 11/29/2022] Open
Abstract
Leiomyosarcoma of the scrotum is a rare genital malignancy with approximately 35 reported cases in literature. We present a case of leiomyosarcoma of the scrotum in a 71-year-old man appearing as a sebaceous cyst that later developed ulcerations. However, because the irregular mass developed ulcerations, this should trigger one to consider that lesion is potentially malignant. The pathology report demonstrated malignant spindle cell neoplasm consistent with leiomyosarcoma, which tested positive for desmin and actin stains. On literature review, a study reported a 5-year survival rate of 50%-80%. The clinical features, diagnosis, histopathologic images, and treatment are reviewed.
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Affiliation(s)
- Bankim Patel
- Ross University School of Medicine, 2300 SW 145th Avenue, Suite 200 Miramar, FL 33027
| | - Anup Vora
- Chesapeake Urology Associates, Sliver Spring, MD, USA
| | - Nicolas Muruve
- Department of Urology, Cleveland Clinic Florida, Weston, FL
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Matias M, Carvalho M, Xavier L, Teixeira JA. Paratesticular sarcomas: two cases with different evolutions. BMJ Case Rep 2014; 2014:bcr-2014-205808. [PMID: 25145896 DOI: 10.1136/bcr-2014-205808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paratesticular sarcomas are rare and account for less than 1% of all adult sarcomas. Intrascrotal tumours can be testicular or paratesticular, paratesticular tumours being rarer (7-10%). Only 30% of paratesticular tumours are malignant and 90% of these are sarcomas. Histological subtypes include leiomyosarcoma, rhabdomyosarcoma, liposarcoma and undifferentiated high-grade pleomorphic sarcoma. Recurrence is frequent in this type of tumour and can occur years from initial diagnosis. These reports show two cases of paratesticular sarcoma with very distinct evolutions. The first case concerns a patient who presented with low-grade leiomyosarcoma with two local recurrences treated with surgery, and distance recurrence with cutaneous, subcutaneous, pulmonary and hepatic metastasis 30 years after surgery of the primary tumour. The second case reports of a patient who presented with high-grade myxoid liposarcoma with local and distance recurrence 3 years after surgery of the primary tumour, which progressed after chemotherapy; the patient died 7 months after diagnosis of recurrence.
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Affiliation(s)
- Margarida Matias
- Department of Medical Oncology, Hospital Garcia de Orta, Almada, Portugal
| | - Miguel Carvalho
- Department of Urology, Hospital Garcia de Orta, Almada, Portugal
| | - Luisa Xavier
- Department of Medical Oncology, Hospital Garcia de Orta, Almada, Portugal
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Radaelli S, Desai A, Hodson J, Colombo C, Roberts K, Gourevitch D, Gronchi A. Prognostic factors and outcome of spermatic cord sarcoma. Ann Surg Oncol 2014; 21:3557-63. [PMID: 24802908 DOI: 10.1245/s10434-014-3751-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate management and outcome in a large series of patients with spermatic cord sarcomas (SCS), a rare malignancy. METHODS Eighty-two patients with localized SCS treated at two dedicated sarcoma units between 1992 and 2013 were included. Disease-specific survival (DSS) and crude cumulative incidence of local recurrence and distant metastases (DM) were estimated by Kaplan-Meier plots and log rank tests. RESULTS Median follow-up was 33 months (interquartile range 13-72 months). Sixty-one patients presented with primary disease. Liposarcoma was the most common histotype, but surprisingly, 37 % of tumors were of high grade. Seventeen patients (21 %) received radiotherapy and 12 patients (15 %) chemotherapy. Five-year DSS for the whole series was 92 % [95 % confidence interval (CI) 83-97]. Five-year rates of local recurrence and DM were 26 % (95 % CI 15-42) and 24 % (95 % CI 15-38), respectively. Tumor grade was found to be a significant predictor of both DSS and DM (both p < 0.001). Quality of surgical margins was proved to affect the local outcome (p = 0.025), while the rates of distant metastases were found to differ significantly by histology (p = 0.010). Exclusively in the liposarcoma subgroup, quality of surgical margins was also directly associated with DSS (p = 0.043). CONCLUSIONS Wide excision of the tumor is critical for cure, especially in the liposarcoma subgroup. The role of radiotherapy and chemotherapy is not established.
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Affiliation(s)
- Stefano Radaelli
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Galosi AB, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Giustini L, Cheng L, Montironi R. Adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of spermatic cord leiomyosarcoma. Diagn Pathol 2014; 9:90. [PMID: 24885500 PMCID: PMC4039061 DOI: 10.1186/1746-1596-9-90] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 01/25/2023] Open
Abstract
Background The aim of this report is related to adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of the spermatic cord leiomyosarcoma. Primary paratesticular tumors are rare, only accounting for 7% to 10% of all intrascrotal tumors. In adults, more than 75% of these lesions arise from the spermatic cord, 20% being leiomyosarcoma. Tumor grade, stage, histologic type, and lymph node involvement are independently predictive of prognosis. Findings The case report concerns a 81-year-old man presented with a 3-year history of painless lump in the right hemiscrotum. Scrotal examination demonstrated a 5.1-cm, firm-to-hard mass attached to the spermatic cord. Scrotal ultrasound scan revealed a heterogeneous mass separate from the testis. He was treated with an radical orchi-funicolectomy. Histologically the lesion is composed of spindled cells with often elongated, blunt-ended nuclei and variably eosinophilic cytoplasm. Areas with pleomorphic morphology are present. The level of mitotic activity is equal to 3/10 HPF in the areas with spindle cell morphology and to 12/10 HPF in the areas with pleomorphic morphology. The final diagnosis was that a leiomyosarcoma of the spermatic cord, with grade 1 and grade 2 areas, stage pT2b cN0 and cM0. The patient has been followed up for 3 months with CT scans and shows no signs of recurrence. Conclusions Spermatic cord leiomyosarcoma, although rare, should be one of the first differential diagnoses for a firm-to-hard lump in the cord. Apart from radical orchi-funicolectomy, there has been added benefit of adjuvant radiotherapy to prevent any loco-regional lymph node recurrence. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1613030331125632
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Affiliation(s)
| | | | | | | | | | | | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I - 60126 Torrette, Ancona, Italy.
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A rare case of paratesticular leiomyosarcoma. Case Rep Urol 2014; 2014:715395. [PMID: 24744951 PMCID: PMC3972873 DOI: 10.1155/2014/715395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/03/2014] [Indexed: 12/01/2022] Open
Abstract
Paratesticular leiomyosarcomas are rare and can lead to significant morbidity and mortality, if inadequately diagnosed or treated. We present a case of paratesticular leiomyosarcoma in an 88-year-old man presenting with a left scrotal mass with ultrasound revealing that the mass is extratesticular. Left radical orchidectomy was performed and pathological examination of the resected specimen confirmed the diagnoses of high grade leiomyosarcoma with surgical margins clear of tumour. The patient was free of metastatic disease on further imaging and has been disease-free for 18 months. A review of the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment is also discussed.
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Akatsuka J, Suzuki Y, Hamasaki T, Kimura G, Osawa S, Kondo Y. Spindle cell sarcoma of the epididymis. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Intrascrotal Dedifferentiated Leiomyosarcoma Originating from Dartos Muscle. Case Rep Urol 2014; 2014:841929. [PMID: 25580348 PMCID: PMC4279120 DOI: 10.1155/2014/841929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/26/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
A 46-year-old man, who had visited our hospital complaining of a small intrascrotal nodule ten years ago, returned to us because of the rapid growth of the nodule. Computed tomography revealed a heterogeneously enhanced intrascrotal tumor of approximately 4 × 3 cm. The tumor and the right testis were excised with the adhered right scrotal skin. The pathological diagnosis was pleomorphic leiomyosarcoma with dedifferentiation originating from the dartos muscle. Urological dedifferentiated leiomyosarcomas are rarely reported and the clinical features are mostly unknown. This is the first report to describe the dedifferentiated leiomyosarcoma of the dartos muscle.
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Rodríguez D, Barrisford GW, Sanchez A, Preston MA, Kreydin EI, Olumi AF. Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes. Urol Oncol 2013; 32:52.e19-25. [PMID: 24239475 DOI: 10.1016/j.urolonc.2013.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Experience with management of spermatic cord tumors (SCTs) is uncommon. We utilized a large population-based cancer registry to characterize the demographic, pathological, treatment characteristics, and outcomes of SCTs. MATERIAL AND METHODS The Surveillance, Epidemiology, and End Results database (1973-2007) was queried. RESULTS From the database, 362 patients were identified with SCT. The annual incidence of SCT was 0.3 cases per million and did not change over time. The most common histologic types were liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%). The median age of diagnosis for rhabdomyosarcomas was (26.3 y), whereas for other SCTs, it was (64.7 y) (P<0.001). On multivariate analysis, a worse outcome was observed with undifferentiated tumor grade, distant disease, positive lymph nodes, and leiomyosarcoma or histiocytoma cell histology. CONCLUSION We describe the largest cohort of SCT studied to date. Liposarcoma was most common, while leiomyosarcoma and histiocytoma histologic subtypes were observed to be the most aggressive. Multivariate analysis revealed that tumor grade, stage, histologic type, and lymph node involvement were independently predictive of prognosis.
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Affiliation(s)
- Dayron Rodríguez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Glen W Barrisford
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Alejandro Sanchez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Mark A Preston
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Evgeniy I Kreydin
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Aria F Olumi
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA.
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Adult inguinoscrotal sarcomas: outcome analysis of 21 cases, systematic review of the literature and meta-analysis. World J Urol 2013; 32:445-51. [DOI: 10.1007/s00345-013-1124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
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