Case Discussion

Histological findings confirmed a diagnosis of a liposarcoma of the spermatic cord. 

Primary spermatic cord tumors are rare yet clinically significant urologic lesions that affect patients of all ages. They are the most common tumors of the paratesticular region and generally present as asymptomatic, slow-growing, firm, palpable paratesticular masses. Although most of them are benign comprised primarily of lipomas, a minority are potentially life-threatening malignant tumors. The most common reported malignant histological types include liposarcomas, leiomyosarcomas, rhabdomyosarcomas, malignant fibrous histiocytoma, and fibrosarcomas. 

The recommended treatment is surgery in the form of wide local excision which in most cases is in the form of radical high orchiectomy from as close to the deep ring as possible. There is no indication for routine lymph node dissections as the loco-regional lymph nodes are rarely involved. The outcome is fairly good in most cases if the resection is R0 (microscopic freedom from cancer). Adjuvant radiotherapy is usually not required except in cases with positive margins or local recurrence and poor prognostic factors. There is no definite role of chemotherapy and most of the recommendations are based on cases with recurrences. These cancers are, however, known for local recurrences and long-term follow-up of up to 10 years is mandatory; even recurrences after 20 years have been reported.