A case of enormous retroperitoneal liposarcoma with prolapse from the left inguinal canal following hernia repair

Abstract

Background: Liposarcomas represent ~9.8-16% of soft tissue sarcomas, with the extremities and retroperitoneum being the primary sites of occurrence. While liposarcoma in the inguinal region is uncommon, few reported cases originate from the retroperitoneum and protrude into the scrotum through the inguinal canal. Here, we present a case of a retroperitoneal liposarcoma with prolapse from the left inguinal canal into the scrotum following hernia repair with a mesh plug.

Case presentation: A 55-year-old male patient underwent a CT scan for a suspected recurrent inguinal hernia, which revealed a sizeable adipose-dense tumor by the left kidney extruded through the left inguinal canal surrounding the scrotum. The patient had undergone mesh plug repair for a left inguinal hernia at another hospital one year ago and noticed ipsilateral inguinal swelling after the hernia repair. The patient was referred to our hospital. The tumor resection was completed with combined resection of potentially involved organs: left side colon, left kidney, and left adrenal gland. Also, complete excision of the tumor was accomplished through surgical resection of the posterior wall of the inguinal canal, the mesh plug, and the tumor extending into the scrotum. Given the nearly complete absence of the inguinal canal's posterior wall and the anterior wall's torn state, sutures were employed to close the external obturator tenosynovitis. Additionally, the inguinal ligament was closed using a tension-free incision technique. Only a mesh was subsequently placed. The resected tumor measured 47 × 30 × 15 cm and 7.5 kg in weight. After surgical resection, a retroperitoneal liposarcoma diagnosis was established. After 2 years and 6 months following the surgical resection, no recurrence has been observed for either liposarcoma or inguinal hernia.

Conclusion: The previous inguinal hernia in this case must be a prolapse of retroperitoneal liposarcoma. Thus, it is recommended to conduct a preoperative examination, which should include a CT scan, since the presence of a fatty mass within the hernia may indicate the presence of a retroperitoneal liposarcoma. Even if a preoperative diagnosis cannot be made, a long-term prognosis can be expected if the retroperitoneal liposarcoma can be completely resected at reoperation.

Keywords: Inguinal hernia; Retroperitoneal; Sarcoma.

Fig. 1

a. Contrast-enhanced CT imaging exhibited a substantial adipose-dense tumor originating from the caudal aspect of the left kidney. b. The tumor has been extending through the left inguinal canal, and reaching the scrotum (indicated by arrows). c. Notably, the mesh plug that had been implanted one year earlier was visibly protruding due to the presence of the tumor (indicated by arrowheads)

Fig. 2

a1,2. The tumor was visibly exerting pressure on the left colon and left kidney. b1,2. Given the extensive involvement, a combined resection of the left colon and left kidney was undertaken. c1,2. The tumor was entirely excised through the resection of the posterior wall of the inguinal canal, the mesh plug, and the tumor's extension into the scrotum

Fig. 3

The resected tumor measured 47 × 30 × 15 cm and 7.5 kg in weight

Fig. 4

Pathological examination confirmed the tumor's identity as a well-differentiated liposarcoma (a. H.E.×100 b. MDM2×200)