Spermatic cord leiomyosarcoma

Last revised by Dr Jeremy Jones on 20 Sep 2021

Spermatic cord leiomyosarcomas are uncommon malignant paratesticular masses.

Accounts for ~10% of spermatic cord sarcomas. The average of a patient at presentation is 58 years old (although has been seen as young as 15 years old).

Patients may have left inguinal swelling (typically painless).

As with other leiomyosarcomas, they arise from smooth muscle (in this instance smooth muscle in the spermatic cord). On gross pathology they appear as firm, smooth masses, which may demonstrate some necrosis and hemorrhage.

Although imaging findings can contribute to a differential diagnosis, biopsy is usually needed for diagnosis.

Primary modality for evaluation

  • heterogeneous
  • hypoechoic
  • increased vascularity on color Doppler
  • more often in the scrotal part of the spermatic cord (lipoma more often at inguinal part)
  • imaging features not defined

Treatment usually consists of transinguinal radical orchiectomy with adjuvant radiation therapy and chemotherapy.

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Cases and figures

  • Case 1: Spermatic cord liposarcoma with leiomyosarcomatous components
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