First reported case of adult paratesticular myxofibrosarcoma in Indonesia: Case report and literature review

Abstract

Introduction and importance: Myxofibrosarcoma is one of the rarest sarcoma types, found in para-testicular regions of the elderly. Although this tumor is detectable by MRI, there has been no specific guideline for managing its recurrence.

Case presentation: A 49-year-old male with a painless scrotal mass was studied. The patient had no other complaint, and the laboratory results showed unremarkable testicular tumor markers. Ultrasound examination of the right hemiscrotum shows a solid mass in the scrotum and right inguinal that compressed the right hemitesticle. MRI examination of the scrotal region revealed a homogeneous solid mass, while at the lower abdomen, it showed a mass extending from the inguinal canal to the penis shaft and right testis. The patient had no signs of metastatic disease, but after high ligation orchidectomy, a rare paratesticular myxofibrosarcoma was revealed from histopathology examination.

Clinical discussion: Based on existing data and patient MRI imaging, total surgical excision with high ligation orchidectomy is the only curative therapeutic option for low-grade tumors. Furthermore, no recurrent mass was identified during follow-up, and adjuvant chemotherapy or radiotherapy was not administered. The patient was satisfied with the surgery and is on a 6-month routine follow-up to observe the physical symptoms.

Conclusion: This is the first adult paratesticular myxofibrosarcoma case in Indonesia, and it was performed with radical orchidectomy with high ligation due to its invasiveness. However, adjuvant chemotherapy was not provided because the benefit remained inconclusive. The result showed that this approach produces excellent outcome without any relapse.

Keywords: Case report; Myxofibrosarcoma; Paratesticular tumor; Radical orchidectomy.

Fig. 1

Clinical picture of the right paratesticular tumor.

Fig. 2

Ultrasonography evaluation of the testis.

Fig. 3

Imaging of Magnetic Resonance Imaging with the contrast of the lower abdomen. (a) frontal view (b) sagittal view. A right intrascrotal mass was found with a clear margin sized 7,5 × 9,4 × 14,9 cm that compressed the testicle inferiorly.

Fig. 4

Intraoperative documentation. (a) intraoperative surgery, (b-c) Macroscopic view of the resected tumor.

Fig. 5

Histopathological evaluation in this patient. (A) & (B) shown densely packed tumor mass with infiltrative margins (HE 40×). (C) Blood vessels proliferate and mostly form a curvilinear pattern (HE 100×). (D) a proliferation of spindle- and stellate-shaped cells diffusely dispersed between the loose myxoid matrix. Tumor cells with mucin-filled vacuolated cytoplasm (pseudolipoblasts) were also seen (HE 400×). (E) the structure and configuration of the seminiferous tubules were within normal limits. (HE 100×).

Fig. 6

Clinical picture of 2-month post-operative.