Image Description
Paratesticular liposarcomas are rare tumors that usually involve spermatic cord (almost 80% of cases) followed by testicular tunics and epididymis. The age range in one of the largest studies (see Ref.) was 41-87 years with a mean age at presentation of 63 years. Most patients present with a painless paratesticular mass which is commonly diagnosed clinically as inguinal hernia. The tumor size ranges from 3 to 30 cm. Grossly, they are often well-demarcated and have yellow-white lobulated lipoma-like appearance. Image copyright: pathorama.ch.
Ref: Montgomery E, Fisher C. Paratesticular Liposarcoma : A Clinicopathologic Study. Am J Surg Pathol 27(1):40-47, 2003.
About the Disease
Malignant tumors of testicular adnexa are quite rare and include genitourinary sarcomas, mesotheliomas, carcinoma of the epididymis, and metastases. Genitourinary sarcomas in adults usually involve spermatic cord, epididymis and surrounding soft tissues. The most common genitourinary sarcoma in adults is well-differentiated liposarcoma, followed by leiomyosarcoma, undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma), and embryonal rhabdomyosarcoma. Embryonal rhabdomyosarcoma is the most common histologic subtype in children and men below 30 yrs. Most of these tumors are bulky and present as painless, palpable mass. Besides embryonal rhabdomyosarcoma, another malignant tumor that may involve the paratesticular region in children is desmoplastic small cell tumor. Mesothelioma may arise from the tunica vaginalis and present as a painless scrotal mass along with a hydrocele. It may be associated with asbestos exposure.Paratesticular sarcomas are managed with wide excision of the spermatic cord and testis with high ligation via an inguinal approach. Incompletely resected tumors are treated by repeat wide local excision and/or post-operative radiation. The long-term survival of men with paratesticular sarcomas is around 50%.