Liposarcoma of the spermatic cord: a diagnostic dilemma

Malignant lesions of the spermatic cord are rare with only around 100 cases reported in the world literature.1–5 Most of these cancers are sarcomas that present as slow-growing inguinal or scrotal masses. There have been occasions when an effort had to be made to differentiate them from inguinal hernias, funicular cysts, lipomas of the cord, et cetera.3–6 Preoperative diagnosis is not common and usually they present as operative or histological surprises. The recommended treatment is surgery in the form of wide local excision which in most cases is in the form of radical high orchiectomy from as close to the deep ring as possible. There is no indication for routine lymph node dissections as the loco-regional lymph nodes are rarely involved. The outcome is fairly good in most cases if the resection is R0 (microscopic freedom from cancer). Adjuvant radiotherapy is usually not required except in cases with positive margins or local recurrence and poor prognostic factors. There is no definite role of chemotherapy and most of the recommendations are based on cases with recurrences. These cancers are, however, known for local recurrences and long-term follow-up of up to 10 years is mandatory; even recurrences after 20 years have been reported.5–7