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Open Access Highly Accessed Short report

Adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of spermatic cord leiomyosarcoma

Andrea B Galosi1, Marina Scarpelli2, Roberta Mazzucchelli2, Antonio Lopez-Beltran34, Lucio Giustini5, Liang Cheng6 and Rodolfo Montironi2*

Author Affiliations

1 Urology Division, “Augusto Murri” General Hospital, Fermo, Italy

2 Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I - 60126 Torrette, Ancona, Italy

3 Unit of Anatomic Pathology, Department of Surgery, Faculty of Medicine, Cordoba, Spain

4 Fundação Champalimaud, Lisbon, Portugal

5 Oncology Division, “Augusto Murri” General Hospital, Fermo, Italy

6 Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

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Diagnostic Pathology 2014, 9:90  doi:10.1186/1746-1596-9-90

Published: 6 May 2014

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 webcite

Keywords:
Leiomyosarcoma of the spermatic cord; Mesenchymal tumors of the scrotum; Spermatic cord; Liposarcoma; Malignant fibrous histiocytomas; Rhabdomyosarcoma