Delayed Diagnosis of a Testicular Mass During COVID-19 Pandemic in Lombardy: A Case Report

Abstract

Signs and symptoms associated with testicular and paratesticular structures should not be underestimated because they may hide diseases requiring immediate evaluation and treatment, such as germline tumors or sarcomas, with the latter histotypes being more common among elderly patients. Unfortunately, the COVID-19 pandemic in Italy has led to a diagnostic delay of several malignancies and the impact of this delay has likely been underestimated. Paratesticular leiomyosarcoma represents a very rare subtype of sarcoma. Here we describe a 57-year-old man who presented to the emergency department with dyspnea and a voluminous mass in the right paratesticular region. At the appearance of the scrotal mass 9 months prior, he had refused to undergo a urological evaluation due to fear of contracting COVID-19. We present this case for its histological rarity and to document a case of diagnostic and therapeutic delay during the pandemic in Lombardy.

Keywords: COVID-19; diagnostic delay; leiomyosarcoma; mass of the testis; pandemic.

Figure 1

Chest computerized tomography showing the testicular mass, a second 4.4 cm nodule in the spermatic cord, and multiple solid lesions in both lungs, 15cm in maximum diameter.

Figure 2

(A) Spindle cell sarcoma with subtotal substitution of testis parenchyma. On higher power, severe cytological atypia and pleomorphism, with frequent mitotic figures including atypical forms (inset). (B) Some areas of the tumor with microcystic spaces lined by atypical myogenic cells. Note the tight connection with tunica vaginalis. (C) The tumor comprises fascicles of atypical spindle cells with a strong immunopositivity for Desmin, and (D) high proliferative index ki67. (E) The assessment of MDM2 gene amplification by fluorescence in situ hybridization (FISH) resulted negative.