1
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Khan M, Baia M, Fiore M, Colombo C, Callegaro D, Pasquali S, Gronchi A, Radaelli S. Initial local resection versus early referral for spermatic cord sarcoma: Any impact on treatment timelines and oncological outcomes? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108269. [PMID: 38520783 DOI: 10.1016/j.ejso.2024.108269] [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: 01/01/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the oncological outcomes of spermatic cord sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how initial inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre. METHODS One hundred eighteen consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 2001 through January 2021 were included. Primary endpoints were local relapse free (LRFS), distant metastasis free (DMFS) and overall survival (OS). These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to known patient, tumour and treatment-related prognostic factors, including a prior inadequate resection and time from diagnosis to a complete oncologic resection as independent variables. Secondarily, we compared the above variables and treatment intervals among the subgroups of primary versus re-resection surgery. RESULTS Over a median follow-up of 54 months (IQR 25-105), 12 patients (10.2%) developed local recurrence (LR) and 14 (11.6%) had distant metastasis (DM). 5-year local relapse (LRFS) and distant metastasis-free survival (DMFS) were 89.3% and 86.5%, respectively. Higher tumour grade and size were associated with a worse DMFS (p=<0.05). Likewise, marginal (R1) resection correlated with an inferior LRFS (p=< 0.05). Eighty-four patients (71.2%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). During the same period, 34 (28.8%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group). The two groups had statistically significant differences in tumour size, histopathology, surgery duration, rate of postoperative complication and R0 resection (p < 0.005). Additionally, the difference in time intervals to achieve the treatment targets was statistically insignificant and did not correlate to the risk of recurrence as an independent variable. Residual disease was present in 51.2 % (n = 43) of the re-excision specimens. However, following a complete R0 resection, this did not correlate with a higher risk of recurrence (p = 0.481). CONCLUSION Prompt referral to a tertiary centre, where multidisciplinary evaluation and sound oncologic resections are the standard of treatment, can align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. The primary determinant of prognosis remains surgical margin, tumour size and grade.
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Affiliation(s)
| | - Marco Baia
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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2
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Hua R, Zhao L, Xu L, Sun J, Huang J, Hua Q. Recurrent paratesticular giant liposarcoma: A case report and literature review. Front Surg 2023; 10:1171952. [PMID: 37181598 PMCID: PMC10172677 DOI: 10.3389/fsurg.2023.1171952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary paratesticular liposarcoma is rarely diagnosed among urinary tumors. In this study, through the retrospective analysis of clinical data and literature review, a case of recurrent paratesticular liposarcoma with lymph node metastasis after radical resection has been reported to explore novel strategies for the diagnosis, treatment and prognosis of this rare disease. Case summary The present case involved a patient who was misdiagnosed as a left inguinal hernia for the first time two years ago, but was later diagnosed as mixed liposarcoma by using postoperative pathology. Currently, he is readmitted to the hospital with a recurrence of the left scrotal mass for more than 1 year. Combined with the patient's past medical history, we performed radical resection of the left inguinal and scrotal tumors and lymphadenectomy of left femoral vein. The postoperative pathology indicated that well-differentiated liposarcoma was accompanied by mucinous liposarcoma (about 20%), and lymph node metastasis of left femoral vein both of which occurred at the same time. After the operation, we recommended the patient to receive further radiation therapy, but the patient and his family refused, hence we followed up the patient closely for a long time. During the recent follow-up, the patient reported no complaints of discomfort, and no recurrence of mass in the left scrotum and groin area. Conclusion After conducting extensive review of literature, we conclude that radical resection remains the key to treat primary paratesticular liposarcoma, while the significance of the lymph node metastasis is still unclear. The potential effects of postoperative adjuvant therapy depends on the pathological type, and hence close follow-up observation is essential.
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Affiliation(s)
- Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Li Xu
- Department of Urology, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Qiyan Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
- Correspondence: Qiyan Hua
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3
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Zhang ZY, Hong P, Deng SH, Tang SY, Liu Z, He HY, Ma LL, Zhang SD, Tian XJ. Spermatic cord anastomosing hemangioma mimicking a malignant inguinal tumor: A case report and literature review. Front Surg 2022; 9:930160. [PMID: 35937604 PMCID: PMC9354528 DOI: 10.3389/fsurg.2022.930160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal imaging examination. AH located in the inguinal region is even rare. We present the diagnosis and treatment of a patient with spermatic cord AH in detail and conduct a literature review. Case Report An 84-year-old Chinese man had swelling pain in his right scrotum. A hard and fixed mass was palpable in the right inguinal region. Preoperative radiological examination considered it a neurogenic or vascular tumor. Malignant soft tissue sarcoma could not be excluded. He underwent radical inguinal right orchiectomy under intraspinal anesthesia. The diagnosis of spermatic cord AH was confirmed by pathological examination. The patient recovered uneventfully and remained disease-free during an 18-month follow-up. Conclusion Spermatic cord AH is quite rare and could be misdiagnosed as a malignant tumor. Pathological evidence might be necessary. The optimal choice of treatment should be determined through a comprehensive assessment of both tumor and patient factors.
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Affiliation(s)
- Zhan-yi Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shao-hui Deng
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shi-ying Tang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hui-ying He
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Lu-lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Shu-dong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
| | - Xiao-jun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
- Correspondence: Lulin Ma Shudong Zhang Xiaojun Tian
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4
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Taylor AT, Dason S, Zynger DL. Clinicopathologic Features of Scrotal Leiomyosarcoma: Single Institutional Experience of Ten Cases. Hum Pathol 2022; 124:96-102. [DOI: 10.1016/j.humpath.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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5
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Aashita, Sharma R, Yadav V, Divya T, Kaur N. Paratesticular epithelioid sarcoma: A rare case. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Fankhauser CD, Issa A, Lee EWC, Oing C, Oliveira P, Parnham A, Oates J, Sangar V, Gulamhusein A, Clarke N. Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre. Ann Surg Oncol 2021; 28:9217-9222. [PMID: 34272613 PMCID: PMC8591003 DOI: 10.1245/s10434-021-10315-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Hemiscrotectomy with en bloc orchidectomy represents a radical primary, completion, or salvage option in men with inguinoscrotal cancers. We describe our surgical technique and peri-operative and oncological outcomes. PATIENTS AND METHODS Retrospective cohort study of 16 men treated at a supra-regional referral centre with open radical hemiscrotectomy with or without en bloc orchidectomy between 2010 and 2020. Peri-operative and survival outcomes were analysed. RESULTS Radical hemiscrotectomy with or without en bloc orchidectomy was performed on 16 patients comprising 7 well-differentiated liposarcomas, 4 dedifferentiated liposarcomas, 2 leiomyosarcomas, 1 mesothelioma, 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma. Primary hemiscrotectomy was performed in four, completion hemiscrotectomy in nine and salvage hemiscrotectomy in three. The median hospital stay was 2 days [interquartile range (IQR) 2-4]. Four patients (25%) had post-operative complications including wound infection or haematoma. During a median follow-up of 18 months (IQR 2-66), one patient (6%) died following a recurrence in the pelvis and retroperitoneum. DISCUSSION and Conclusions If careful dissection is performed, radical hemiscrotectomy and en bloc orchidectomy is a radical but safe procedure with a short hospital stay. Haematoma and infection represent the main complications, and within limited follow-up most men showed no recurrence.
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Affiliation(s)
| | - Allaudin Issa
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Esther W C Lee
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Christoph Oing
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Eppendorf, Hamburg, Germany
| | - Pedro Oliveira
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Arie Parnham
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Jeremy Oates
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK.,University of Manchester, Manchester, UK
| | - Aziz Gulamhusein
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK
| | - Noel Clarke
- Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK.,The Salford Royal NHS Foundation Trust, Manchester, UK
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7
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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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8
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Ng M, Pascoe J, Kugathasan G, Parsons B. Paratesticular liposarcoma: a rare cause of scrotal lump. BMJ Case Rep 2021; 14:14/2/e240008. [PMID: 33568414 PMCID: PMC7878152 DOI: 10.1136/bcr-2020-240008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paratesticular tumours are tumours arising from within the scrotum not of testicular origin. They may originate from the epididymis, spermatic cord, tunica vaginalis and other supporting structures. Preoperative diagnosis can be difficult as benign and malignant cases are often indistinguishable and may be confused with other benign or malignant pathology (testicular tumours or hernias).We describe the presentation and management of a patient managed at our centre (a tertiary referral teaching hospital).A high index of suspicion for malignancy should be considered when managing atypical scrotal lumps to ensure optimal management. This is particularly important when managing sarcomas due to the risk of local recurrence and spread.
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Affiliation(s)
- Michael Ng
- Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Gana Kugathasan
- Radiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Brian Parsons
- Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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9
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Koschel SG, Wong LM. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer. Transl Androl Urol 2020; 9:3094-3102. [PMID: 33457282 PMCID: PMC7807348 DOI: 10.21037/tau.2019.12.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.
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Affiliation(s)
- Samantha G Koschel
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Lih-Ming Wong
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
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10
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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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11
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Paul PAM, Calton N, Arnestina S, Mammen KJ. Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India. Ann Diagn Pathol 2020; 50:151658. [PMID: 33189965 DOI: 10.1016/j.anndiagpath.2020.151658] [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: 09/16/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period. METHODS All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details. RESULTS A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma. CONCLUSION PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.
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Affiliation(s)
- Preethi A M Paul
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
| | - Nalini Calton
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sarah Arnestina
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Kim J Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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12
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Abstract
PURPOSE OF REVIEW The presence of vascular solid tumors within the testicle is considered to be malignant until proven otherwise. However, it is prudent for clinicians to be aware of rare benign and malignant intratesticular lesions as management can differ from the established treatment algorithms for germ-cell tumors. RECENT FINDINGS Utilizing certain histopathologic findings can assist with the diagnosis of rare testis tumors. Often times the tumor subtypes are an important consideration in the grading and classification of the disease, which drives management. The multidisciplinary management of rare malignant testis tumors at an experienced center seems to provide optimal patient outcomes. Regardless of the primary treatment, prolonged follow-up for sex cord stromal tumors and other rare testis malignancies is advocated due to the delayed metastatic potential. SUMMARY The clinical presentation of rare benign and malignant testis tumors is often similar to that of germ-cell tumors. Likewise, imaging characteristics are also often indistinguishable. However, the management of these rare tumors is often different from the well established treatment algorithms of germ-cell tumors. To that end, it is important for the practicing urologist to be familiar with the current principles of these tumor characteristics and the management.
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13
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Noguchi T, Fukushima T, Hara H, Sekiguchi N, Kobayashi T, Ozawa T, Gomi D, Koizumi T. Giant paratesticular liposarcoma with lung metastases: a case report and review of the literature. J Med Case Rep 2020; 14:86. [PMID: 32611426 PMCID: PMC7330966 DOI: 10.1186/s13256-020-02420-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 05/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Due to its rarity, little is known about the clinical presentations and responses to systemic chemotherapies in advanced and/or metastatic cases of paratesticular liposarcoma. CASE PRESENTATION Here, we report the case of a 75-year-old Japanese man with giant paratesticular liposarcoma. Imaging studies revealed a 26 cm tumor in his right scrotum and lung metastases at presentation. He underwent radical orchiectomy followed by systemic chemotherapies. Pathological findings of the resected primary tumor confirmed a dedifferentiated liposarcoma. He then started chemotherapy treatment with gemcitabine plus docetaxel. His disease status was stable for 1 year. Eribulin was used for second-line chemotherapy. He had a relapse at 5 months after eliburin and died at 22 months after diagnosis. CONCLUSION Early diagnosis and curative radical surgery are important for treatment of paratesticular liposarcoma. However, a giant paratesticular liposarcoma could cause metastases, and systemic chemotherapy may be helpful for prolonging survival in patients with metastatic paratesticular liposarcoma.
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Affiliation(s)
- Takuro Noguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hiroaki Hara
- Department of Urology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takesumi Ozawa
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Daisuke Gomi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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