A Rare Case of Paratesticular Leiomyosarcoma

Paratesticular leiomyosarcomas are rare and can lead to significant morbidity and mortality, if inadequately diagnosed or treated. We present a case of paratesticular leiomyosarcoma in an 88-year-old man presenting with a left scrotal mass with ultrasound revealing that the mass is extratesticular. Left radical orchidectomy was performed and pathological examination of the resected specimen confirmed the diagnoses of high grade leiomyosarcoma with surgical margins clear of tumour. The patient was free of metastatic disease on further imaging and has been disease-free for 18 months. A review of the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment is also discussed. 1. Introduction We report the first documented case of paratesticular leiomyosarcoma diagnosed and treated in Australia. A review of the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment is also discussed. 2. Case An 88-year-old male presented to his urologist with a tender swelling of his left testicle. There were no associated lower urinary tract or constitutional symptoms. His past history included prostate adenocarcinoma diagnosed 13 years prior to presentation, for which he had undergone transurethral resection of the prostate and regular monitoring. Physical examination revealed a 2？cm swelling arising from the upper pole of the left testicle. The mass was subcutaneous, firm, and tender. Scrotal ultrasonography identified a left sided hydrocele as well as an altered area of echogenicity at the upper pole of the left testis extending into the epididymis measuring approximately 15？mm in diameter. Prostate specific antigen was unchanged from previous measurements. The patient underwent an elective left radical orchidectomy. The surgical specimen weighing 75？g consisted of testis, epididymis, and spermatic cord. It contained a 35 × 30 × 26？mm firm mass centred on paratesticular tissues adjacent to the upper pole of the left testis extending into the epididymis with a grey/white cut surface. Histologically, the tumour consisted of interweaving fascicles of cytologically malignant spindle shaped cells (Figure 1) with frequently bizarre nuclei. Abnormal mitotic figures were scattered throughout the lesion (Figure 2) and focal tumour necrosis was identified. The radial and spermatic cord resection margins were within normal tissue. Immunohistochemical stains were strongly positive for vimentin and smooth muscle actin (Figure 3). Histological features were consistent with a diagnosis of high grade leiomyosarcoma.