Giant Paratesticular Liposarcoma Mimicking a Left-Sided Groin Hernia: A Case Report

Abstract

Giant paratesticular liposarcoma (PLS) is an uncommon tumour, often misdiagnosed pre-operatively, which presents as a painless scrotal mass. Early detection and prompt surgical management provide the best outcome. We present an 87-year-old patient with gradually enlarging, painless left scrotal swelling. Ultrasound on initial presentation suggested a benign hernia, resulting in an 11-month treatment delay. Computed tomography (CT) thereafter showed paratesticular scrotal mass measuring 14 x 8 x 7cm. Radical inguinal orchidectomy with high ligation of the spermatic cord was performed. Histopathology and cytogenetics confirmed PLS with both de-differentiated and well-differentiated features involving the spermatic cord margin. The patient had rapid progression to fatal lung metastasis within three months of surgery. Our case highlights that any suspicious fat swelling should be investigated thoroughly and excised promptly if paratesticular liposarcoma is suspected, as delayed management gives poor outcomes.

Keywords: dedifferentiated liposarcoma; giant liposarcoma; paratesticular liposarcoma; paratesticular tumors; testicular mass.

Figure 1. CT abdominal-pelvis scan

The image is showing left paratesticular liposarcoma measuring ~14cm.

Figure 2. Giant fleshy lobulated paratesticular liposarcoma

Figure 3. Immunohistochemistry image

H&E 10X The image shows a transition from well-differentiated to de-differentiated liposarcoma

Figure 4. Spermatic cord margin involved by well-differentiated liposarcoma

H&E 10X