Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 47, Num. 1, 2001, pp. 52-53

Journal of Postgraduate Medicine, Vol. 47, Issue 1, 2001 pp. 52-53

Myxoid Liposarcoma of the Spermatic Cord

Kashid YS, Bakshi GK, Joshi AS,* Mohite JD

Department of General Surgery and Pathology*, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai - 400 012, India.

Code Number: jp01002

Case History

An 80-year-old man presented with a rapidly increasing swelling in the left inguinoscrotal region of three months’ duration and a lump on the same side of lower abdomen, since two months.

On examination, the patient had hard, immobile, retroperitoneal lump continuous with left cord structures. Computerised tomographic (CT) scan showed a well defined inguinoscrotal mass of mixed density (soft tissue and fat attenuation) extending into pelvis and left side of retroperitoneum upto the lower pole of the left kidney, without associated lymphadenopathy. The diagnosis was liposarcoma of spermatic cord with extension into retroperitoneum. Search for metastases in lungs and liver did not reveal any.

At laparotomy, we found a large, well-encapsulated and hard tumour in the left retroperitoneum, pushing the bowel loops, bladder and left ureter towards right side and it was continuous with the left inguinoscrotal swelling. The testis was separate and normal. The aorta and IVC were free from the tumour. Complete excision of the retroperitoneal and inguino-scrotal tumour with left orchidectomy was done (Figure 1).

Microscopically, it showed a highly cellular spindle cell tumour with variegated appearance showing fascicles, loose myxoid areas and poorly cellular areas. There were many multinucleate tumour giant cells, lipoblasts, stellate cells and compressed vascular channels. Frozen section and Oil Red O stain showed abundant fat in the tumour cells (Figure 2). Histopathological diagnosis was myxoid liposarcoma of the spermatic cord with extension into retroperitoneum.

In our patient though complete excision of the tumour was possible, we could not get wider margin for radical excision. Hence, the patient was advised postoperative radiotherapy. The patient had local recurrence and liver metastasis within three months and succumbed later.

Discussion

Myxoid liposarcoma is rarely found in the spermatic cord. It tends to occur in the elderly, presenting as painless scrotal swelling and is often confused with hydrocele or chronic incarcerated inguinal hernia. (1) Till 1997, only 14 cases of myxoid liposarcomas have been reported. (2) Of these one was a giant tumour weighing 42 kg. (3) This tumour may arise from the cord tissue representing extension of retroperitoneal fat or as malignant transformation of a preexisting lipoma. It generally behaves like a well differentiated liposarcoma.1 CT scan is diagnostic of liposarcomas. Wide excision with orchidectomy is the treatment of choice for spermatic cord liposarcomas. Local recurrence is commoner than distant metastasis. (4) Retroperitoneal lymphadenectomy is not recommended as retroperitoneal lymph nodal spread is unlikely. (5,6) Adjuvant radiotherapy is recommended in well-differentiated and myxoid type if local control is not complete. This may reduce the incidence of locoregional recurrence. (7) Benefit of chemotherapy is controversial. (4) Myxoid liposarcoma of the spermatic cord being a low grade, well-differentiated sarcomas it does not recur with a higher grade or in less-differentiated form.1 Local recurrence is best treated by wide excision, but the prognosis is poor. (8)

References

1. Mcfadden D. Myxoid liposarcoma of the spermatic cord. J Surg Oncology 1989; 40:132-134. MEDLINE
2. Ikinger U, Westrich M, Pietz B, Mechtersheimer G, Schmidt C. Combined myxoid liposarcoma and angiolipoma of the spermatic cord. Urology 1997; 49:635-637. MEDLINE
3. Yol S, Tavli S, Tavli L, Belviranli M, Yosunkaya A. Retroperitoneal and scrotal giant liposarcoma. Surgery Today 1998; 28:339-342. MEDLINE
4. Morotta J, Dardenne B, Beauduin M, Darimont M, Timmermans L, Schmitz A. Liposarcoma of the spermatic cord. Acta Urologica Belgica 1996; 64:37-41. MEDLINE
5. Blitzer PH, Dosoretz DE, Proppe KE, Shipley WU. Treatment of malignant tumours of spermatic cord. A study of 10 cases and review of literature. J Urol 1981; 126:611-614. MEDLINE
6. Enzinger FM, Weiss SW. Liposarcoma. In: Enzinger FM, Weiss SW, editors. Soft Tissue Tumours, 3rd ed. USA: Mosby; 1995; pp 431-466.
7. Fagundes MA, Zerman AL, Althausen AF, Coen JJ, Shipley WU. The management of spermatic cord sarcoma. Cancer 1996; 77:1873-1876. MEDLINE
8. Lauretti S, Cappa M, Emiliozzi P, Casareale P, Ianari A, Defido L. Retroperitoneal Liposarcoma. Minerva Chirurgica 1998; 53:77-81. MEDLINE

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