Abstract
Primary tumors of the paratesticular region are rare, with paratesticular sarcomas constituting a major proportion of these tumors, particularly in the elderly. The paratesticular region consists of mesothelial, various epithelial and mesenchymal cells and may therefore give rise to a number of tumors with various behaviors. Defining the association between the paratesticular mass and the testicle, and differentiation between benign and malignant masses using radiology is challenging, therefore the mass is usually considered to be malignant and radical orchiectomy with high ligation is performed. The present study reports the cases of seven patients with tumors of the paratesticular region and presents the clinical and significant histological features of the tumors. In total, two patients suffered from dedifferentiated liposarcoma (DDLS), two exhibited leiomyosarcoma, two exhibited low-grade fibromyxoid sarcoma and one case of undifferentiated pleomorphic sarcoma was identified. Radical orchiectomy with high ligation was performed in five cases; simple orchiectomy was performed in one case and excisional biopsy was performed in the remaining case. A leiomyosarcomatous and epithelial membrane antigen (EMA) positive whorl pattern was observed during microscopy in the two DDLS cases. Additionally, one of the low-grade fibromyxoid sarcoma patients exhibited pleomorphism and mitosis in focal areas. To the best of our knowledge, the present study is the second time low-grade fibromyxoid sarcoma cases with paratesticular localization have been reported in the literature. Of the seven cases, four patients succumbed to the disease, one patient is living with the disorder and the two cases of DDLS are living without the disease. Paratesticular sarcomas are often aggressive and a multidisciplinary approach is required for the diagnosis and treatment of these tumors.
Highlights
As the paratesticular region contains various structures, including the epididymis, spermatic cord, tunica vaginalis and strong fat‐ligament‐muscle supporting tissues, it may give rise to a number tumor types with various behaviors [1]
The most significant feature of the paratesticular region is that it is the origin of a small number of tumors with rich diversity
The present study reports seven cases of paratesticular sarcoma and emphasizes the significant clinical and histological features
Summary
As the paratesticular region contains various structures, including the epididymis, spermatic cord, tunica vaginalis and strong fat‐ligament‐muscle supporting tissues, it may give rise to a number tumor types with various behaviors [1]. The present study reports seven cases of paratesticular sarcoma and emphasizes the significant clinical and histological features. A homologous pattern consisting of well‐differentiated liposarcoma, comprising predominantly spindle cells, was present in each case (Fig. 1). Immunohistochemical staining of the cells revealed that the whorl pattern area was positive for epithelial membrane antigen (EMA; Fig. 4). Microscopy revealed the histology to be similar in the two cases, with the prominent features consisting of a collagen and myxoid zone, mixed with bland spindle‐like fibroblastic cells and a whorl pattern, and arcades of curvilinear blood vessels The mass in case seven had infiltrative borders, and, microscopically, was rich in spindle cells, with small bundles and storiform patterns. Immunohistochemical staining yielded a positive result for vimentin only This case was diagnosed as undifferentiated pleomorphic sarcoma.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
