Liposarcoma of the spermatic cord

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient presented with a growing groin mass.

Patient Data

Age: 65-70Y
Gender: Male

CT

Modality: CT

There is a heterogeneous soft tissue enhancing mass in the left scrotum superior to the left testis and involving the spermatic cord measuring 3.7 x 3.1 x 5.0 cm (AP x trans x CC). A small left hydrocoele is noted. The left and right testes are homogenous. This mass appears to be confined within the scrotal sac wall, with no extension into the subcutaneous tissue or skin. No left inguinal hernia.

No intra-abdominal lymphadenopathy. No hepatic lesion. The liver, spleen and adrenals are within normal limits. Simple cysts noted in both kidneys. Fatty atrophy of the pancreas. The small and large bowels are unremarkable.

No focal bony destructive lesion.

CONCLUSION: Heterogeneous soft tissue enhancing mass confined to left scrotal sac separate from the left testis, but involving the spermatic cord. No left inguinal hernia. This is concerning for a primary neoplastic process. 5 mm pulmonary nodule in the lateral segment of the right middle lobe and 11 mm left hilar lymphadenopathy as described.

Modality: Ultrasound

There is expansion of the left spermatic cord in the left groin, extending down into the scrotum. The spermatic cord is expanded by a heterogenous mass, encasing the vessels of the spermatic cord. There is no herniation of bowel into the spermatic cord. The left testis is normal in appearance.

Conclusion

Heterogenous mass expanding the left spermatic cord - there is no bowel herniation. It is unclear what the underlying mass is, but not a simple lipoma, and it is not herniation.

The patient underwent left orchidectomy. Histology of the spermatic cord lesion confirmed liposarcoma.

Review of CT hip and leg (on contralateral side; for other reason) from approximately 2 years ago:

Modality: CT

At the 'edge of the film' there is abnormal soft tissue within the left inguinal canal, which has now increased in size.

Case Discussion

Liposarcoma of the spermatic cord is rare. Around 100 cases are reported worldwide. Most are slow growing as in this case, and differentiation between hernia and lipoma is often not possible on imaging grounds.

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Case Information

rID: 30562
Case created: 19th Aug 2014
Last edited: 1st Mar 2016
Inclusion in quiz mode: Included

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