Spermatic cord liposarcomas are the most common malignant tumour of the spermatic cord. Most present as painless, slow-growing masses and can be mistaken for inguinal hernias. They are usually well-differentiated and spread by local extension. 

Epidemiology

In a large population-based registry, the annual incidence of spermatic cord tumour (SCT) is 0.3 cases/million ³.

Clinical presentation

Most present as painless, slow-growing masses. They can be mistaken for an inguinal hernia, hydrocele, or other paratesticular tumours. 

Pathology

Most are low-grade and well-differentiated and spread by local extension. High-grade tumours can spread via haematogenous or lymphatic routes ³. 

In a large population-based registry, 362 patients with SCT were identified, with histological subtypes of liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%) ³. 

Radiographic features

CT and MRI provide greater characterisation and staging information than ultrasound. They appear as a fat-containing tumour with variable amounts of soft tissue, nodularity, and septations. 

Treatment and prognosis

Standard surgical treatment includes high orchidectomy and resection of the tumour and spermatic cord. Lymph node dissection is occasionally performed. Chemotherapy and radiation therapy depend on the tumour grade, stage, and risk of recurrence¹. 

Differential diagnosis

Lipoma is the most common benign tumour of the spermatic cord, and much more common than liposarcoma (45% of paratesticular masses)³. Other malignant tumours of the spermatic cord include leiomyosarcoma, histiocytoma, and rhabdomyosarcoma. 

See also

• paratesticular lesions