1. PARATESTICULAR LMS
CITY ONCOLOGIST MEET
28/02/2014

2. PARATESTICULAR
LMS
16YRS/M
 LT SCROTAL SWELLING – 1YR
DURATION
 RECENT ONSET PAIN
 UNDERWENT LT HIGH INGUINAL
ORCHIDECTOMY BY THE GEN
SURGEON (29/07/2013)
 DEFAULTED FOR ADJUVANT
 CT SCAN ABDOMEN- PARA AORTIC
LYMPHADENOPATHY (04/02/2014).

3. PARATESTICULAR
LMS
•
• HP NO :6450/13
•
Macroscopy – radical
high orchidectomy
specimen
10.5x6.5x6cm.
Cord 4cm in length
. Testis could be made out
compressed . The surface
was greyish and nodular.
Cut section firm and not
variegated.

4. PARATESTICULAR
LMS

5. PARATESTICULAR
LMS

6. PARATESTICULAR
LMS

7. PARATESTICULAR
LMS

8. PARATESTICULAR
LMS
Microscopy
Revealed a highly
cellular spindle cell
tumour with a fascicular
arrangement.
Mitotic score - 5/10 HPF.
There was no necrosis.
Histologic grade -
FNLCC - Grade 1 ( total
score 3/9 )

9. PARATESTICULAR
LMS

10. PARATESTICULAR
LMS

11. PARATESTICULAR
LMS

12. PARATESTICULAR
LMS

13. REVIEW OF LITERATURE
Clementine. Rama Rao, M.D., M. Srinivasulu, M.D., K.N. Naresh,
M.D., D.C.P., D.C. Doval, M.D., M.A.M.S. D. Hazarika, M.D.,
Adult Paratesticular Sarcomas : A Report of Eight Cases
Journal of Surgical Oncology, 1994;56:89-93
Eight adult paratesticular sarcomas seen at a Regional Cancer
Centre over a 7-year period are described. There were three
cases of rhabdomyo sarcoma (RMS), three cases of
leiomyosarcoma (LMS), and two cases of liposarcoma (LS).
The RMS occurred in a younger age group (3rd decade) than
the LMS and LS (6th and 7th decades). Most of our patients
presented with advanced disease after orchiectomy at other
hospitals, three with recurrent or residual disease and four
with metastasis. The single patient with RMS who received
intensive adjuvant therapy is free of disease at 84 months in
spite of the advanced stage at presentation. All three
patients with LMS had an unfavourable clinical course. Both
the patients with LS had well differentiated (WD) tumours and
presented with recurrences, one over several years following
initial local excisions.

14. REVIEW OF LITERATURE
Urología Oncológica
Arch. Esp. Urol., 57, 5 (525-530), 2004
LEIOMIOSARCOMA PARATESTICULAR. REVISIÓN Y PUESTA AL DÍA.
Roberto Llarena Ibarguren, Víctor Azurmendi Sastre, Jesús Martín
Bazaco, Ainara Villafruela
Summary.- OBJECTIVES: To present one case of
paratesticular leiomyosarcoma, a rare tumor which has
been reported in 5 cases only in our country. To review
the management of this type of tumor.
METHODS: A 73-year-old male presenting with a 4 cm
mass adjacent to the right testicle underwent excision of
the mass, spermatic cord and testicle through an inguinal
approach.
RESULTS: The tumor was classified as a grade 3
leiomyosarcoma, with positive immunohistochemical
staining for desmin and smooth muscle actin. After this
pathology report we did not consider adjuvant oncological
treatment. Tumor relapse has not appeared so far.

15. REVIEW OF LITERATURE
A rare cause of a scrotal mass: primary leiomyosarcoma of epididymis
Maher Mechri, Samir Ghozzi, Ramzi Khiari, Fethi Bougrine, Ammar
Bouziani, Nawfel BenRais Published 26 February 2009 BMJ Case Reports 2009;
doi:10.1136/bcr.06.2008.0292
Summary
Most masses encountered within the scrotal sac are neoplastic and occur
within the testis; however a subset (2–3%) of these tumours is extra-
testicular and usually arises from paratesticular tissue. Although
uncommon, these tumours have a high incidence of malignancy
reaching 30%, mainly represented by sarcomas (90%). Tumours
occurring in the paratesticular region may be clinically indistinguishable
from testicular tumours, thus resulting in initial misdiagnosis. In
addition, the clinical findings are by no means specific to a tumour type
and cannot distinguish between a benign and a malignant tumour, which
results in difficulty in diagnosis and management. All paratesticular
tumours are amenable to adequate surgical resection. Definite
diagnosis is determined by histological evaluation.
Leiomyosarcoma, the second most common paratesticular sarcoma after
liposarcoma, is represented in the literature primarily as case reports.
We report a case of LMS arising from the epididymis and focus on
clinical presentation and differential diagnosis of such tumour.