Liposarcoma of the Spermatic Cord Masquerading as an Inguinal Hernia

This is a case of a 70-year-old male who presented with a mass in his right testicle. He was treated with antibiotics for epididymitis while undergoing serial ultrasounds for one year due to testicular swelling and pain. His fourth ultrasound revealed a mild hydrocele with a large paratesticular mass of undescribed size, superior to the right testicle, thought to be an inguinal hernia. Preoperative CT scan demonstrated a large fat-containing inguinal hernia extending into the scrotal sac. An inguinal hernia repair was complicated by fatty tissue surrounding the testicle requiring a right orchiectomy. Pathology review of the tissue demonstrated well-differentiated liposarcoma with a small focus of dedifferentiation grade 2 tumor. Tumor was identified at the inked margins indicating an incomplete resection. It was decided that no further surgical intervention was needed and the patient would undergo surveillance for local tumor recurrence. Six-month follow-up MRI scan was negative for any recurrence of disease. A liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare, and imaging studies may fail to distinguish a liposarcoma from normal adipose tissue. 1. Introduction Liposarcoma is a malignant soft tissue sarcoma typically occurring in the thigh or retroperitoneum in an adult. However, a liposarcoma presenting as a paratesticular mass with spermatic cord involvement is rare. The first reported case was in 1845 and only 100 cases are found in the literature [1]. The diagnosis is hard to obtain due to the tumor being low grade and difficult to distinguish from an inguinal hernia due to adipose tissue composition when viewed on MRI, CT, or ultrasound [2]. 2. Case A 70-year-old male presented to his internal medicine primary care physician with a mass and swelling of his right testicle. Initial evaluation demonstrated a negative polymerase chain reaction (PCR) test for gonorrhea and chlamydia. Beta-human chorionic gonadotropin (HCG), lactate dehydrogenase (LDH), and -fetoprotein (AFP) tests were within normal limits. He was treated empirically with antibiotics for epididymitis before the laboratory results returned. A screening testicular ultrasound demonstrated an extratesticular mass thought to be an inguinal hernia because of its reducibility on exam. Since it was reducible and he was not in pain, no further workup or surgical intervention was performed. On continued follow-up appointments with his primary care physician, he noted increasing swelling and pain at the site of the mass, prompting a repeat ultrasound. The