A 37-pound scrotal leiomyosarcoma: a case report and literature review

Scrotal wall leiomyosarcoma: a case report and review of the literature

BACKGROUND

Up to 30% of all scrotal masses are sarcomas. Leiomyosarcoma of the scrotal wall is rare, and its clinical significance and prognosis have not been well defined, since the most reported cases have little or no follow-up.

CASE PRESENTATION

We report a 45-year-old Caucasian man who was admitted with a firm, nontender, mobile scrotal wall mass from 15 months ago. Laboratory data including testicular tumor markers were within normal range, and transscrotal ultrasonography revealed an oval-shaped, hypoechogenic, solid mass with blood flow and well-defined border. Histopathologic examination and immunohistochemistry staining, following surgical excision, were in favor of malignant leiomyosarcoma.

CONCLUSION

Here we describe the morphological features and immunohistochemical presentations of the tumor and the patient's relatively long-term follow-up.

Leiomyosarcoma of the scrotum: a case report and literature review

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.

Subcutaneous leiomyosarcoma of the scrotum mimickering testicular cancer. A case report and literature review

Leiomyosarcoma of the scrotum is a rare tumor. Johnson H Jr in 1987 reported first case. Only 39 cases been reported in the literature. A 74 years old Indian gentleman presented with progressive painless right testicular swelling for 3 months. On examination, a firm right testicular mass. We proceeded with right scrotal exploration with excision of the right scrotal mass. Histopathology showed scrotum leiomyosarcoma. We would like to discuss the rarity of presentation, dilemma of diagnosis and managing in a district hospital. We advocate wide local excision with clear margin of 2 cm which give good overall survival benefits.

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

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.

Scrotal leiomyosarcoma associated with bilateral epididymo-orchitis

Leiomyosarcoma of the scrotum is a rare tumor. We report the case of a 60-year-old man who presented with bilateral testicular enlargement that was clinically misdiagnosed as a testicular tumor. The tumor was excised by bilateral inguinal orchiectomy. Histopathologic examination revealed a scrotal wall leiomyosarcoma with bilateral epididymo-orchitis.

[Scrotal leiomyosarcoma with bone metastasis]

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options

Cutaneous smooth muscle is present in 3 separate locations: arrector pili muscles, blood vessel walls, and genital/areolar skin. Benign or malignant smooth muscle neoplasms may arise from each of these locations. This review discusses the pathogenesis, clinical manifestations, histologic findings, prognosis, treatment options, and controversial areas of cutaneous smooth muscle neoplasms. ( J Am Acad Dermatol 2002;46:477-90.)

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be able to discuss the pathogenesis, clinical manifestations, histologic findings, prognosis, and treatment options of cutaneous smooth muscle neoplasms.

Leiomyosarcoma of the paratesticular region: a clinicopathologic study

The behavior of leiomyosarcoma (LMS) is site related, but there are limited data on such tumors presenting in the paratesticular region. Cases diagnosed as LMS of the paratesticular region from the files of three institutions were reviewed. Immunohistochemistry was performed in cases with available blocks, and follow-up information was obtained. From 31 cases originally diagnosed as LMS, 24 were retained after review. These were from men aged 34-86 years (mean 62 years; median 64 years) and involved the testicular tunica (10), spermatic cord (10), scrotal subcutis and dartos muscles (1 each), and the epididymis (1). Tumors ranged in size from 2-9 cm (mean 5 cm; median 4 cm). On immunohistochemical staining they expressed muscle-specific actin (13 of 14), smooth muscle actin (10 of 10), desmin (16 of 17), and CD34 (3 of 9); all of the latter three were strongly desmin-positive. Focal reactivity for cytokeratin (3 of 8) and S-100 protein (1 of 8) was seen. Follow-up information was available in 14 patients. Four (29%) had recurrences, in one case four times. Metastases to lymph nodes, lungs, or liver were seen in four patients (29%), of whom two had prior recurrences. Ten were alive with no evidence of disease (ANED), and four were dead of disease (DOD). Comparing outcome with tumor grade, all seven patients with grade 1 tumors (of whom two had recurrences) and all three with grade 2 tumors were ANED, whereas all four patients with grade 3 tumors were DOD. In summary, paratesticular LMSs are rare neoplasms. The majority in this site are low-grade, although high-grade lesions behave aggressively.

Recurrent cutaneous leiomyosarcoma

BACKGROUND

Soft tissue sarcomas comprise approximately 0.7% of all malignant neoplasms. Superficial leiomyosarcoma, a rare malignant lesion, constitutes 4.0-6.5% of all soft tissue sarcomas, an overall incidence of approximately 0.04% among all cancers. Currently, less than 125 cumulative cases of cutaneous and subcutaneous leiomyosarcoma have been reported in the English literature.

METHODS

The authors report the case of a 70-year-old Japanese man with recurrent cutaneous leiomyosarcoma who was treated by wide local excision. A comprehensive literature survey is also presented.

RESULTS

The patient is free from recurrence 1 year after wide local excision of a second recurrence of cutaneous leiomyosarcoma. Moreover, superficial leiomyosarcoma can be subdivided into cutaneous leiomyosarcoma and subcutaneous leiomyosarcoma, based on histopathologic and prognostic differences.

CONCLUSIONS

The treatment of choice of superficial leiomyosarcoma is wide local excision. Cutaneous leiomyosarcoma is associated with local recurrence only, although subcutaneous leiomyosarcoma undergoes metastatic spread in 30-60% of cases, with a 30-40% mortality rate.

Non-germ cell tumors of testis

Testicular tumors of non-germ cell origin represent from 5 percent to 10 percent of all testicular neoplasms. Included in this group are sex cord/gonadal stromal tumors, most originating from Leydig or Sertoli cells, mixed tumors, and tumors of mesenchymal or hematopoietic origin. In addition, various miscellaneous lesions, tumor-like conditions, and secondary testicular tumors may be classified as non-germ cell tumors. This review covers the presentation, diagnosis, and treatment of these rare lesions.

Primary leiomyosarcoma of the testis

We report a case of primary leiomyosarcoma of the testis, which was believed to originate from normal testicular structures containing smooth muscle cells, such as blood vessels and contractile cells of the seminiferous tubules. No evidence of tumor spread was found. Treatment consisted of orchiectomy with high ligation of the spermatic cord. The patient received no adjuvant therapy. There was no evidence of tumor after 2 years. The literature is reviewed and the therapeutic approach is discussed.