PARATESTICULAR LMS CITY ONCOLOGIST MEET 28/02/2014

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16YRS/M LT SCROTAL SWELLING – 1YR DURATION RECENT ONSET PAIN UNDERWENT LT HIGH INGUINAL

ORCHIDECTOMY BY THE GEN SURGEON (29/07/2013)

DEFAULTED FOR ADJUVANT CT SCAN ABDOMEN- PARA AORTIC

LYMPHADENOPATHY (04/02/2014).

PARATESTICULARLMS• • HP NO :6450/13

•   Macroscopy – radical high orchidectomy specimen 10.5x6.5x6cm. Cord 4cm in length . Testis could be made out compressed . The surface was greyish and

nodular. Cut section firm and not variegated. 

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Microscopy Revealed a highly cellular spindle cell tumour with a fascicular arrangement.Mitotic score - 5/10 HPF. There was no necrosis.Histologic grade - FNLCC - Grade 1 ( total score 3/9 )

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REVIEW OF LITERATUREClementine. Rama Rao, M.D., M. Srinivasulu, M.D., K.N. Naresh,M.D., D.C.P., D.C. Doval, M.D., M.A.M.S. D. Hazarika, M.D.,

Adult Paratesticular Sarcomas : A Report of Eight CasesJournal of Surgical Oncology, 1994;56:89-93

Eight adult paratesticular sarcomas seen at a Regional Cancer Centre over a 7-year period are described. There were three cases of rhabdomyo sarcoma (RMS), three cases of leiomyosarcoma (LMS), and two cases of liposarcoma (LS). The RMS occurred in a younger age group (3rd decade) than the LMS and LS (6th and 7th decades). Most of our patients presented with advanced disease after orchiectomy at other hospitals, three with recurrent or residual disease and four with metastasis. The single patient with RMS who received intensive adjuvant therapy is free of disease at 84 months in spite of the advanced stage at presentation. All three patients with LMS had an unfavourable clinical course. Both the patients with LS had well differentiated (WD) tumours and presented with recurrences, one over several years following initial local excisions.

REVIEW OF LITERATUREUrología OncológicaArch. Esp. Urol., 57, 5 (525-530), 2004LEIOMIOSARCOMA PARATESTICULAR. REVISIÓN Y PUESTA AL DÍA.Roberto Llarena Ibarguren, Víctor Azurmendi Sastre, Jesús Martín

Bazaco, Ainara Villafruela

Summary.- OBJECTIVES: To present one case of

paratesticular leiomyosarcoma, a rare tumor which hasbeen reported in 5 cases only in our country. To reviewthe management of this type of tumor.METHODS: A 73-year-old male presenting with a 4 cmmass adjacent to the right testicle underwent excision ofthe mass, spermatic cord and testicle through an inguinalapproach.RESULTS: The tumor was classified as a grade 3leiomyosarcoma, with positive immunohistochemicalstaining for desmin and smooth muscle actin. After thispathology report we did not consider adjuvant oncologicaltreatment. Tumor relapse has not appeared so far.

REVIEW OF LITERATUREA rare cause of a scrotal mass: primary leiomyosarcoma of epididymis

Maher Mechri, Samir Ghozzi, Ramzi Khiari, Fethi Bougrine, Ammar Bouziani, Nawfel BenRais Published 26 February 2009 BMJ Case Reports 2009; doi:10.1136/bcr.06.2008.0292

SummaryMost masses encountered within the scrotal sac are neoplastic and occur within

the testis; however a subset (2–3%) of these tumours is extra-testicular and usually arises from paratesticular tissue. Although uncommon, these tumours have a high incidence of malignancy reaching 30%, mainly represented by sarcomas (90%). Tumours occurring in the paratesticular region may be clinically indistinguishable from testicular tumours, thus resulting in initial misdiagnosis. In addition, the clinical findings are by no means specific to a tumour type and cannot distinguish between a benign and a malignant tumour, which results in difficulty in diagnosis and management. All paratesticular tumours are amenable to adequate surgical resection. Definite diagnosis is determined by histological evaluation.

Leiomyosarcoma, the second most common paratesticular sarcoma after liposarcoma, is represented in the literature primarily as case reports. We report a case of LMS arising from the epididymis and focus on clinical presentation and differential diagnosis of such tumour.