Spermatic cord leiomyosarcoma

Spermatic cord leiomyosarcomas are uncommon malignant paratesticular masses.

Epidemiology

Accounts for ~10% of spermatic cord sarcomas. The average of a patient at presentation is 58 years old (although has been seen as young as 15 years old).

Clinical features

Patients may have left inguinal swelling (typically painless).

Pathology

As with other leiomyosarcomas, they arise from smooth muscle (in this instance smooth muscle in the spermatic cord). On gross pathology they appear as firm, smooth masses, which may demonstrate some necrosis and hemorrhage.

Radiographic features

Although imaging findings can contribute to a differential diagnosis, biopsy is usually needed for diagnosis.

Ultrasound

Primary modality for evaluation

  • heterogeneous
  • hypoechoic
  • increased vascularity on color Doppler
  • more often in the scrotal part of the spermatic cord (lipoma more often at inguinal part)
MRI
  • imaging features not defined

Treatment and prognosis

Treatment usually consists of transinguinal radical orchiectomy with adjuvant radiation therapy and chemotherapy.

See also