|Year : 2001 | Volume
| Issue : 2 | Page : 186-188
Leiomyosarcoma of paratesticular tissue
Erel Diaz, Shivanand Prabhu, Kirubanand
Department of Surgery, KMC Hospital, Attavar, India
Department of Surgery, KMC Hospital, Attavar, Mangalore - Karnataka
Source of Support: None, Conflict of Interest: None
Keywords: Leiomyosarcoma; Paratesticular Tissue
|How to cite this article:|
Diaz E, Prabhu S, Kirubanand. Leiomyosarcoma of paratesticular tissue. Indian J Urol 2001;17:186-8
| Introduction|| |
Mesenchymal tumours of the paratesticular structures are rare. Out of these mesenchymal tumours, rhabdomyosarcoma in its juvenile form accounts for approximately 40% of all paratesticular tumours, benign and malignant. Leiomyosarcoma appears to be the second most common lesion in this area.  A case report of leiomyosarcoma of paratesticular tissue occurring in a 60-year-old man is presented and a review of literature is done.
| Case Report|| |
A 60-year-old male presented to us with large scrotal mass and dull aching pain in right scrotum of 6-months' duration. There was no history of micturition or bowel disturbances.
There was no systemic illness or no history of antecedent trauma. On examination a mass 8x7 cm in size, well circumscribed and variable in consistency was found in the right scrotum extending up to the superficial inguinal ring. Testis was palpated separately. Abdominal examination findings were normal. Suspecting a epididymal cyst, USG of the scrotum was done. It showed a mixed echogenic lesion arising from the body/head of epididymis suggesting a infected or haemorrhagic epididymal cyst. Routine blood and Urine biochemical investigation were normal. Plain X-ray KUB and that of chest were normal. The mass was explored by inguinal route and incision over the mass revealed a solid swelling. It was removed by inguinal orchidectomy and high ligation of the cord was done. On gross inspection, it appears circumscribed [Figure - 1]. The cut surface is solid, grayish white and patches of necrosis can be noted around the central portion of the lesion [Figure - 2]. The post-operative period was uneventful and the histopathology report was leiomyosarcoma of the paratesticular tissue. The patient was given a course of post-op chemotherapy and is doing well after 8 months of follow-up with no evidence of local recurrence or distant metastasis.
In low power field, tumour tissue shows plump slender tumours cells arranged in fascicles of various sizes. In some places the fascicles are intersecting in perpendicular and in some area in intervening fascicular pattern. In high power field, the cells are pleomotphic in nature, at places multinucleation of cells are seen. Mitosis is very high approximately 10/10 HPF with occasional atypical mitosis [Figure - 3]. Features are suggestive of moderately differentiated leiomyosarcoma. Slide is stained with Eosin and Haematoxylin.
| Discussion|| |
Smooth muscle tumours of the paratesticular tissue are rare and their exact incidence is difficult to determine, first because the clinical and histological difference between benign smooth muscle tumour and malignant ones are slight and second because some adenomatoid tumour are erroneously classified as leiomyomas.  90% of the extratesticular tumours occurring within the scrotum are found in the spermatic cord. Of the latter 30% are malignant and 70% are benign.  There are about 25 cases reported of leiomyosarcoma of the spermatic cord.  Local invasion of adjacent tissues was found in many cases. The first recurrence was usually local in the scrotum or at the distal spermatic stump. Distal spread has been haematogenous in a large number of cases.
The philosophy and planning of treatment have been greatly affected by the mode of spread. It is agreed that all cases of tumour of the spermatic cord should be explored and the growth should be removed. If it is benign, simple excision is all that is necessary. The standard therapy for Ieiomyosarcoma has been radial orchidectomy in which high ligation of the cord is carried out. Radio-therapy can be used for local tumours even when the tumour is generalized. Chemotherapy consisting of cycles of sequential administration of dactinomycin, doxorubicin, vincristine and cyclophosphamide for 2 years in patients with gross macroscopic or microscopic residual tissue appears to be promising in improving the survival rates. 
| References|| |
|1.||Richie JP. Neoplasms of testis. In: Patric CW, Alan BR, Vaughan ED (eds.). Campbell's Urology. Saunders, Philadelphia. 1998; 2444-2453. |
|2.||Gowing NE Morgan AD. Paratesticular tumours of connective tisuue and muscle. Br J Urol 1964; 36: 78. |
[Figure - 1], [Figure - 2], [Figure - 3]