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|Year : 1980 | Volume
| Issue : 2 | Page : 145-6
Leiomyosarcoma of hydrocele sac (a case report).
Sane SY, Nimbkar SA, Bapat RD
|How to cite this article:|
Sane S Y, Nimbkar S A, Bapat R D. Leiomyosarcoma of hydrocele sac (a case report). J Postgrad Med 1980;26:145
The term paratesticular tumor is used for intrascrotal tumors arising from epididymis, spermatic cord and tunics. Majority of these are connective tissue tumors and are sufficiently rare to be recorded in the literature as a single case or small series. Here is a case of leiomyosarcoma arising from the wall of hydrocele sac.
A seventy eight year old patient was admitted with history of scrotal swelling-hydrocele of 19 years' duration. There was an increase in size for the past 6 months. On examination, he was found to be an emaciated old patient with bilateral pulmonary tuberculosis. Local examination revealed a huge right-sided scrotal swelling with hard consistency. Tapping was done 5 months ago and one and half litre fluid was drained. Patient was readmitted and this time the mass was excised under local anaesthesia with clinical diagnosis of long standing hydrocele with hemorrhage or ?malignancy of testes.
The patient expired 8 days after operation due to poor general condition, pulmonary tuberculosis with bronchopneumonia. Autopsy was not available.
The specimen was 20 x 20 x 15 cms. in size; it was a dense connective tissue mass weighing 1.r' kg with pale grey cut surface [Fig. 1]. Areas of hemorrhage were seen. The mass was seen attached to the thickened hydrocele sac. The testes was compressed at one surface of the tumor.
Histological sections revealed atrophic testes and epididymis, thickened and collagenised tunica and hydrocele sac wall with cholesterol deposit. Sections from the mass [Fig. 2] showed it to be a malignant tumor composed of spindle cells arranged in bundles, cut at various planes. Masson's trichrome and Van-Gieson stains confirmed it to be leiomyosarcoma. The tumor was seen arising from the thickened tunica.
Majority of malignant paratesticular tumors are sarcomas. Yet compared to testicular tumors, they are rare. Among 2000 tumors of male genital system in the files of Armed Forces Institute of Pathology only one case is recorded as sarcoma in the scrotum. In a large series of 387 paratesticular tumors reviewed by El-Badawi and Al-Ghorab, 9 were leiomyosarcoma. Williams and Banerjee reviewed 13 cases of leiomyosarcoma in the scrotum, three of which were associated with hydrocele. Presence of hydrocele in association with paratesticular tumor is usually an indication that the tumor is malignant. Leiomyosarcoma at the site is an old man's disease. Local excision may not be adequate since the reported' incidence of metastasis is as high as 29% in cases of sarcoma.
The authors are thankful to the Dean, Seth G. S. Medical College and K.E.M. Hospital for permission to publish this case.
|1.||Banowsky, L. H. and Shultz, G. N.: Sarcoma of the spermatic cord and tunics. Review of the literature, case report and discussion of role of retroperitoneal lymph node dissection, J. Urol., 103: 628-631, 1970. |
|2.||Dixon, F. J. and Moore, R. A.: Tumors of the male sex organs. In, "-Atlas of Tumor Pathology", Washington, Armed Forces Institute of Pathology, 1952, p. 173. |
|3.||El-Badawi, A. A. and Al-Ghorab, M. M.: Tumors of the spermatic cord. A review of the literature and a report of a case of lymphangioma, J. Urol., 94: 445450, 1965. |
|4.||Malik, A. K., Banerjee, A. K. and Parmar, R. S.: Paratesticular malignant mesenchymoma, Indian J. Path. & Microbiol., 21: 251-253, 1978. |
|5.||Williams, G. and Banerjee, R.: Paratesticular tumors, Brit. J. Urol., 41: 332-339, 1969. |