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Liposarcoma of the spermatic cord masquerading as an inguinal hernia.

Londeree W, Kerns T - Case Rep Med (2014)

Bottom Line: It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence.Six-month follow-up MRI scan was negative for any recurrence of disease.A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.

ABSTRACT
This is a case of a 70-year-old male who presented with a mass in his right testicle. He was treated with antibiotics for epididymitis while undergoing serial ultrasounds for one year due to testicular swelling and pain. His fourth ultrasound revealed a mild hydrocele with a large paratesticular mass of undescribed size, superior to the right testicle, thought to be an inguinal hernia. Preoperative CT scan demonstrated a large fat-containing inguinal hernia extending into the scrotal sac. An inguinal hernia repair was complicated by fatty tissue surrounding the testicle requiring a right orchiectomy. Pathology review of the tissue demonstrated well-differentiated liposarcoma with a small focus of dedifferentiation grade 2 tumor. Tumor was identified at the inked margins indicating an incomplete resection. It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence. Six-month follow-up MRI scan was negative for any recurrence of disease. A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

No MeSH data available.


Related in: MedlinePlus

CT abdomen/pelvis read as a large fat-containing inguinal hernia present on the right side extending into the scrotal sac. No bowel loops are contained but there is a significant amount of omentum and fat present.
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fig1: CT abdomen/pelvis read as a large fat-containing inguinal hernia present on the right side extending into the scrotal sac. No bowel loops are contained but there is a significant amount of omentum and fat present.

Mentions: Due to the progressive testicular pain, general surgery was consulted for a right sided inguinal hernia. A preoperative CT scan demonstrated a large fat-containing inguinal hernia on the right side extending into the scrotal sac (Figure 1). On physical exam the mass seemed to be reducible but was very tender to palpation. A urology consult was not obtained prior to surgery since the mass appeared to be composed of adipose tissue and was believed to be an inguinal hernia. He underwent surgery for an inguinal hernia repair, and a prolene hernia system mesh was placed in the preperitoneal space covering the entire myopectineal orifice for a small indirect inguinal hernia. Mobilization of the distal cord and testes was complicated by fatty tissue surrounding the spermatic cord and right testicle. Urology was consulted intraoperatively and a right sided radical orchiectomy was performed; a spermatic cord mass of 14 × 8 × 4 cm which enveloped the spermatic cord was resected with 12 cm of the spermatic cord. The pathology was sent to Joint Pathology Center (JPC), Bethesda, MD. The tissue was consistent with a well-differentiated liposarcoma with a small focus of dedifferentiation grade 2/4 tumor (Figures 2 and 3). Tumor identified at the inked margins indicated incomplete resection. A six-month postoperative CT scan and MRI were negative for any recurrence of disease. The case was discussed in a multidisciplinary tumor board and with the patient. The patient was given treatment options of further surgical resection or surveillance. Given his age, the patient chose surveillance because he did not desire further surgical intervention. The board agreed it was reasonable to conduct surveillance screening due to the anatomical location and the tumor being well differentiated with only a small amount of dedifferentiated tumor present. The patient had serial surveillance with MRI at one year. At eighteen months after resection, there has been no recurrence of disease.


Liposarcoma of the spermatic cord masquerading as an inguinal hernia.

Londeree W, Kerns T - Case Rep Med (2014)

CT abdomen/pelvis read as a large fat-containing inguinal hernia present on the right side extending into the scrotal sac. No bowel loops are contained but there is a significant amount of omentum and fat present.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3926318&req=5

fig1: CT abdomen/pelvis read as a large fat-containing inguinal hernia present on the right side extending into the scrotal sac. No bowel loops are contained but there is a significant amount of omentum and fat present.
Mentions: Due to the progressive testicular pain, general surgery was consulted for a right sided inguinal hernia. A preoperative CT scan demonstrated a large fat-containing inguinal hernia on the right side extending into the scrotal sac (Figure 1). On physical exam the mass seemed to be reducible but was very tender to palpation. A urology consult was not obtained prior to surgery since the mass appeared to be composed of adipose tissue and was believed to be an inguinal hernia. He underwent surgery for an inguinal hernia repair, and a prolene hernia system mesh was placed in the preperitoneal space covering the entire myopectineal orifice for a small indirect inguinal hernia. Mobilization of the distal cord and testes was complicated by fatty tissue surrounding the spermatic cord and right testicle. Urology was consulted intraoperatively and a right sided radical orchiectomy was performed; a spermatic cord mass of 14 × 8 × 4 cm which enveloped the spermatic cord was resected with 12 cm of the spermatic cord. The pathology was sent to Joint Pathology Center (JPC), Bethesda, MD. The tissue was consistent with a well-differentiated liposarcoma with a small focus of dedifferentiation grade 2/4 tumor (Figures 2 and 3). Tumor identified at the inked margins indicated incomplete resection. A six-month postoperative CT scan and MRI were negative for any recurrence of disease. The case was discussed in a multidisciplinary tumor board and with the patient. The patient was given treatment options of further surgical resection or surveillance. Given his age, the patient chose surveillance because he did not desire further surgical intervention. The board agreed it was reasonable to conduct surveillance screening due to the anatomical location and the tumor being well differentiated with only a small amount of dedifferentiated tumor present. The patient had serial surveillance with MRI at one year. At eighteen months after resection, there has been no recurrence of disease.

Bottom Line: It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence.Six-month follow-up MRI scan was negative for any recurrence of disease.A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.

ABSTRACT
This is a case of a 70-year-old male who presented with a mass in his right testicle. He was treated with antibiotics for epididymitis while undergoing serial ultrasounds for one year due to testicular swelling and pain. His fourth ultrasound revealed a mild hydrocele with a large paratesticular mass of undescribed size, superior to the right testicle, thought to be an inguinal hernia. Preoperative CT scan demonstrated a large fat-containing inguinal hernia extending into the scrotal sac. An inguinal hernia repair was complicated by fatty tissue surrounding the testicle requiring a right orchiectomy. Pathology review of the tissue demonstrated well-differentiated liposarcoma with a small focus of dedifferentiation grade 2 tumor. Tumor was identified at the inked margins indicating an incomplete resection. It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence. Six-month follow-up MRI scan was negative for any recurrence of disease. A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue.

No MeSH data available.


Related in: MedlinePlus