Paratesticular sarcomas: our case series

Abstract

Objective: Paratesticular tumors, which comprise a heterogeneous group of entities, are often described in case reports in the literature. In this study, we present histomorphological, immunohistochemical and clinical features of six cases with paratesticular sarcoma.

Material and methods: Six cases with paratesticular sarcoma diagnosed in our hospital between 1997 and 2012 were included in this study. Information regarding treatment modalities, tumor recurrence, metastasis, and survival were obtained from archival patient records. Hematoxylin-eosin sections of the cases were examined, and immunohistochemical analyses were performed for markers including smooth muscle actin, desmin, Ki67, CD34, S100 and myogenin. Percentage of staining in five high-power fields were counted to document Ki67 and p53 nuclear positivity rates.

Results: Of the 6 paratesticular sarcoma cases, 3 were rhabdomyosarcomas, 2 leiomyosarcomas and 1 liposarcoma. The case with sclerotic-type liposarcoma showed two recurrences during the 15-year follow-up period. Two cases with the diagnosis of leiomyosarcoma presented with lung metastases at the time of diagnosis, and 1 patient died of the disease at 7(th) month. Of the 3 cases with rhabdomyosarcomas, 2 patients were lost to postoperative follow up. The other patient presented with liver and prevertebral metastasis at the 3(rd) month and died of the disease in the 14(th) month. The Ki67 proliferation index was significantly higher for one case with rhabdomyosarcoma, and 2 cases with leiomyosarcoma. Differences in p53 expression were not statistically significant between the cases.

Conclusion: Paratesticular tumors belong to a heterogeneous group of tumors that can follow different clinical courses. This study showed that the most important features in determining prognosis are histopathological subtype and tumor grade.

Keywords: Leiomyosarcoma; liposarcoma; paratesticular; rhabdomyosarcoma.

Figure 1.

Bizarre stromal cells dispersed individually in a loose collagenous stroma, and interspersed mature adipocytes (HE ×200)

Figure 2.

Intersecting spindle-shaped tumor cells with hardly seen cytoplasmic borders (HE ×200)

Figure 3.

Hypo-, and hypercellular areas consisting of cells with round, oval nuclei, and indistinct cytoplasms on a myxoid stroma, and individually interspersed better differentiated cells with eosinopilic cytoplasms (HE ×200)