Abstract
Paratesticular liposarcoma is a rare neoplasm, described in single case studies or components of larger studies, as histologically well-differentiated liposarcoma (WDL) and dedifferentiated liposarcoma (DL). However, leiomyosarcomatous differentiation is an extremely rare occurrence in WDL and DL. We report a case of leiomyosarcomatous differentiation in a 77-year-old man. The patient presented with a painless right scrotal mass. Magnetic resonance imaging showed a large mass along the right spermatic cord. The resected mass, measuring 17.5 × 12 × 5 cm, was composed of a high-grade pleomorphic undifferentiated sarcomatous component with necrosis. Atypical smooth muscle differentiation was also detected. Additional tumor sampling revealed the presence of a WDL component. Immunohistochemical analysis of the pleomorphic sarcomatous component showed positive staining for MDM2 and CDK4, and negative staining for alpha smooth muscle actin (αSMA) and desmin. The smooth muscle component was positive for αSMA and desmin, and negative for MDM2 and CDK4. Extension from primary retroperitoneal sarcoma was not proved. We diagnosed of DL with leiomyosarcomatous differentiation.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1484291498104021.
Highlights
Liposarcoma is the most common type of soft-tissue sarcoma, accounting for about 20% of all mesenchymal malignant tumors
A study of 30 cases of paratesticular liposarcoma showed that 19 cases were well-differentiated liposarcoma (WDL), 10 cases were dedifferentiated liposarcoma (DL), and 1 showed a myxoid/round cell liposarcoma [2]
DL is usually composed of atypical lipomatous tumor (ALT)/WDL areas and dedifferentiated components that usually overlap with spindle/pleomorphic cell high-grade sarcoma or myxoid/spindle cell low-grade sarcoma
Summary
Liposarcoma is the most common type of soft-tissue sarcoma, accounting for about 20% of all mesenchymal malignant tumors. It usually arises from the thigh and retroperitoneum. A study of 30 cases of paratesticular liposarcoma showed that 19 cases were well-differentiated liposarcoma (WDL), 10 cases were dedifferentiated liposarcoma (DL), and 1 showed a myxoid/round cell liposarcoma [2]. DL is usually composed of atypical lipomatous tumor (ALT)/WDL areas and dedifferentiated components that usually overlap with spindle/pleomorphic cell high-grade sarcoma or myxoid/spindle cell low-grade sarcoma. Dedifferentiated areas rarely show heterologous differentiation with myogenic, osteo/chondrosarcomatous, or angiosarcomatous elements [3]. Leiomyosarcoma, rhabdomyosarcoma, chondrosarcoma, and osteosarcoma differentiation has been reported in malignant mesenchymal tumor [5]
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