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| Letter to the Editor Georgios Tsakaldimis 1 , Georgios-Ioannis Verras 2 , Michail Pitiakoudis 3 , Christos Kalaitzis 1 , Anastasios Karayiannakis 3 , George Pappas-Gogos 3 , Levan Tchabashvili 4 , Konstantinos Tasios 2 , Angelis Peteinaris 5 , Vasileios Tatanis 5 , Francesk Mulita 2, 4
Gastroenterology Rev Online publish date: 2024/11/26 Article file - Undifferentiated pleiotropic.pdf[0.19 MB] ENWEndNoteBIBJabRef, MendeleyRISPapers, Reference Manager, RefWorks, Zotero AMA APA Chicago Harvard MLA Vancouver Spermatic cord sarcomas comprise arare genitourinary malignancy that presents achallenging diagnostic and therapeutic pathway. They represent less than 5% of all soft-tissue sarcomas and less than 2% of malignant urologic tumours. The most commonly reported subtypes are liposarcoma, leiomyosarcoma, and rhabdomyosarcoma, with other rare variants including undifferentiated pleomorphic sarcoma and desmoplastic round cell sarcoma [1–3]. Due to the rarity of the condition’s nature, it is difficult to evaluate large patient cohorts. However, existing literature of up to 22 patients have indicated the existence of ahighly diverse histological field. Between the different histological subtypes, undifferentiated pleiotropic sarcoma is the rareest subtype with reported incidence as low as 4.5% of all spermatic cord and scrotal sarcomas [4]. The spermatic cord is by far the commonest site of sarcoma occurrence within the genitourinary tract, accounting for approximately 30% to 90% of all cases, depending on the reporting institution. Epidemiologically, the incidence of spermatic duct sarcoma is bimodal, with patients aged 16–20 years showing ahigh incidence rate for rhabdomyosarcoma, and patients older than 60 years constituting the second peak of incidence, with liposarcoma and leiomyosarcoma being the most common subtypes [4]. In most cases, aperson with aparatesticular tumour will experience aswelling on one side of the groin (inguinal) or amass in the scrotum. This swelling or mass may or may not be painful and sometimes there is also abuildup of fluid around the testicle (hydrocele) [2–4]. In rare cases, the first sign of the condition might be sudden severe scrotal pain due to tissue death (necrosis) or bleeding within the tumour. Because the symptoms can be vague, it is crucial to accurately diagnose aparatesticular tumour before surgery to distinguish it from other benign conditions in the groin or scrotum. These benign conditions include inguinal hernias, hydroceles, lipomas, haematoceles, tuberculosis of the epididymis or orchitis (inflammation of the testicle and epididymis), and testicular cancer [4, 5]. Making an accurate diagnosis is essential to avoid incomplete removal of the tumour or contamination of the surgical area during surgery. It must be noted, however, that despite advances in imaging accuracy and new protocols for soft tissue imaging, several cases of spermatic duct sarcomas cannot be differentiated from soft tissue contents of an inguinoscrotal hernia. The diagnosis of spermatic duct sarcoma is often complex due to the rarity of the condition and the absence of well-defined preoperative diagnostic criteria [4–6]. Ultrasound imaging is acommon diagnostic tool that can suggest the presence of atumour, showing ahypoechoic extra testicular scrotal mass that is highly vascularised on Doppler imaging. In the presence of ascrotal mass, ultrasonography serves as the initial imaging modality for localisation purposes. It effectively differentiates intratesticular from paratesticular lesions but may have limitations in distinguishing aherniated adipose tissue component from alipomatous mass. For amore comprehensive evaluation of disease extent beyond the inguinal canal, computed tomography (CT) and magnetic resonance imaging (MRI) are valuable tools [5–7]. These modalities provide detailed information regarding the dimensions and topography of the mass, and its relationship with surrounding anatomical structures. Definitive diagnosis of paratesticular tumours hinges upon histopathological examination of the mass tissue. This can be achieved through surgical resection or percutaneous core biopsy. Due to the relative rarity of these tumours, there is apaucity of robust clinical evidence to guide the development of multimodality treatment strategies. Within this case report, we present the extremely rare case of a66-year-old man who presented with an inguinal mass that proved to be an undifferentiated pleiotropic spermatic duct sarcoma. To the best of our knowledge, this is one of the few reported undifferentiated spermatic duct sarcomas along with the course of treatment. Within the scope of this report, we also aim to briefly present the current knowledge on diagnosis, and current trends on the management of arare soft tissue tumour, which can be unexpectedly encountered by the general surgeon. FundingNo external funding. Ethical approvalApproval numer: 112547-15/2/2024. Conflict of interestThe authors declare no conflict of interest. References1. Ahmed F, Aslam A, Tanveer Y, Jaffry S. Leiomyosarcoma of the spermatic cord: arare paratesticular neoplasm case report. World J Surg Oncol 2022; 20: 94. 2. Chowdhry VK, Kane JM, Wang K, et al. Testicular, spermatic cord, and scrotal soft tissue sarcomas: treatment outcomes and patterns of failure. Sarcoma 2021; 2021: 8824301. 3. Mulita F, Parchas N, Germanos S, et al. Case report of alocal recurrence of spindle cell embryonal rhabdomyosarcoma.Med Arch 2020; 74: 240-2. 4. Stiller CA, Trama A, Serraino D, et al. Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project. Eur J Cancer 2013; 49: 684-95. 5. Kyratzi I,Lolis E,Antypa E, et al. Imaging features of ahuge spermatic cord leiomyosarcoma: review of the literature. World J Radiol 2011; 3: 114-9. 6. Coleman J, Brennan MF, Alektiar K, Russo P. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol 2003; 10: 669-75. 7. Moschini M, Mattei A. Diagnosis and management of spermatic cord tumors. Curr Opin Urol 2017; 27: 76-9. 8. Mondaini N, Palli D, Saieva C, et al. Clinical characteristics and overall survival in genitourinary sarcomas treated with curative intent: amulticenter study. Eur Urol 2005; 47: 468-73. 9. Ap Dafydd D, Messiou C, Thway K, et al. Paratesticular sarcoma: typical presentation, imaging features, and clinical challenges. Urology 2017; 100: 163-8. 10. Dotan ZA, Tal R, Golijanin D, et al. Adult genitourinary sarcoma: the 25-year Memorial Sloan-Kettering experience. J Urol 2006; 176: 2033-9. 11. Russo P, Brady MS, Conlon K, et al. Adult urological sarcoma. J Urol 1992; 147: 1036-7. 12. Stojadinovic A, Leung DHY, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 2002; 235: 424-34. 13. Wang X, Tu X, Tan P, et al. Adult genitourinary sarcoma: clinical characteristics and survival in aseries of patients treated at ahigh-volume institution. Int J Urol 2017; 24: 425-31. 14. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16: 197-203. 15. Verras GI, Mulita F, Bouchagier K, et al. Mid-term outcomes in the treatment of retroperitoneal sarcomas: a12-year single-institution experience.Med Glas (Zenica) 2022; 19(2). doi:10.17392/1498-22. 16. Mulita F, Verras GI, Liolis E, et al. Recurrent retroperitoneal liposarcoma: acase report and literature review.Clin Case Rep 2021; 9: e04717. Copyright: © 2024 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
Undifferentiated pleiotropic spermatic duct sarcoma: a surgical surprise in the inguinal canal that calls for attention (2025)
Table of Contents
Georgios Tsakaldimis 1 , Georgios-Ioannis Verras 2 , Michail Pitiakoudis 3 , Christos Kalaitzis 1 , Anastasios Karayiannakis 3 , George Pappas-Gogos 3 , Levan Tchabashvili 4 , Konstantinos Tasios 2 , Angelis Peteinaris 5 , Vasileios Tatanis 5 , Francesk Mulita 2, 4
Funding
Ethical approval
Conflict of interest
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