Abstract
Paratesticular tumors are rare comprising 7-10% of total intrascrotal tumors of which 70% are benign and 30% are malignant. Leiomyomas and undifferentiated pleomorphic sarcomas are two such rare paratesticular tumors which should be accurately diagnosed for purpose of treatment and prognosis. We report here two cases. In first case, a 65-year-old man presented with paratesticular mass of 12 years duration. Histology showed features of benign spindle cell tumor. On immunohistochemistry the tumor cells were positive for vimentin, desmin, h-caldesmon and SMA. Based on these findings a diagnosis of leiomyoma of scrotum was made. In second case, a 66-year-old male presented with left paratesticular mass of eight months duration. Histology showed features of high-grade sarcoma. On immunohistochemistry tumor cells were focally positive for SMA and negative for h-caldesmon, desmin, calretinin and ALK-1. A final diagnosis of undifferentiated pleomorphic sarcoma of paratesticular region, grade 3/3 was made.
Highlights
Paratesticular tumors are rare comprising 7-10% of total intrascrotal tumors of which 70% are benign and 30% are malignant.[1]
Leiomyoma and undifferentiated pleomorphic sarcoma are two such rare tumors which should be accurately diagnosed for purpose of treatment and prognosis
Scrotal leiomyomas are essentially benign arising from the subcutaneous tissue or dartos muscle.[2]
Summary
Paratesticular tumors are rare comprising 7-10% of total intrascrotal tumors of which 70% are benign and 30% are malignant.[1]. Cut surface showed well circumscribed multilobulated mass seen above the testis measuring 7x6x4cm with pale brown to grey-white areas. Microscopy of the mass showed partly capsulated tumor composed of pleomorphic tumor cells arranged in lobules, sheets with dense lymphoplasmacytic infiltration and areas of collagenous stroma. These cells were spindle to stellate shaped with hyperchromatic nuclei and 1-4 prominent. A final diagnosis of undifferentiated pleomorphic sarcoma, paratesticular region Grade 3/3 (FNCLCC grading system) was made This patient is on regular follow up and he presented with recurrence two years after the excision of mass along with metastasis to the lung and is on chemotherapy. Fig. -1a: Gross specimen of skin covered mass with, B: grey white cut surface;, C: Photomicrograph showing interlacing bundles of spindle cells arranged in fascicles with, D: Elongated bland nuclei (H & E, X 400)
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