Figure 1
NCCT abdomen pelvis axial section in soft tissue window shows a well defined soft tissue density lesion in left inguinal region with no evidence of hemorrhgae/calcifications
A case of leiomyosarcoma of spermatic cord
SectionUroradiology & genital male imaging
Case TypeClinical Cases
Authors
Shraya Mallikarjun Kullolli, M. R. Shashikumar, Manu R.
Connected authors
75 years, male
Clinical History
A 75-year-old male patient presented with history of left lower abdominal pain and palpable left inguinal region mass.
Imaging Findings
On CECT Abdomen and pelvis: A fairly well-defined spindle shaped elongated soft tissue density lesion of 35-40 HU noted epicentered in left inguinal region along the course of left spermatic cord with no evidence of internal calcifications/hemorrhage/fat component.
On post contrast study the lesion shows heterogenous enhancement with internal non-enhancing areas - suggestive of necrosis.
The lesion shows intraabdominal extension superiorly and extending up to the root of scrotum inferiorly.
The lesion is seen abutting left external iliac veins posterolaterally.
Dilated pampiniform plexus noted extending from inferior pole of the lesion to inferior pole of testis.
Moderate left-sided hydrocele noted.
Discussion
Leiomyosarcomas of spermatic cord are rare tumors and constitute for 5-10% of soft tissue sarcomas. Leiomyosarcoma constitute for 10% of paratesticular sarcomas.
Leiomyosarcoma results from neoplastic transformation of smooth muscle cells or multi-potential mesenchymal cells. Paratesticular leiomyosarcoma arise from the spermatic cord, the scrotum (testicular tunica, dartos muscle and scrotal sub cutis) or the epididymis [1].
They are most commonly seen in adults with an average age of presentation of 58 years.
Leiomyosarcoma of spermatic cord are most commonly located in the scrotal part of the spermatic cord. In contrast, leiomyoma of spermatic cord are seen in inguinal part of spermatic cord.
On Ultrasonography, leiomyosarcoma appear as heterogenous lesion with predominant hypoechoic area, typically located in the scrotal part of the spermatic cord [2].
On colour Doppler study, the lesions show minimal/increased internal vascularity [1].
On CT Imaging, the lesion appears heterogenous of 25-60 HU with cystic areas with thick and edematous spermatic cord and distended vessels within the cord.
Dissemination occurs by regional lymph node spread, haematogenous metastasis commonly to the lung and local invasion to scrotum, inguinal canal, pelvis and along the path of vas deferens [1].
Locoregional recurrence is commonly seen. Treatment includes transinguinal radical orchiectomy, with adjuvant radiation therapy to reduce recurrence and chemotherapy for high-grade lesions and distal metastases [2].
Differential Diagnosis List
Leiomyosarcoma of spermatic cord
Benign adenomatoid tumour of spermatic cord
Spermatic cord rhabdomyosarcomma
Adenocarcinoma of spermatic cord
Angiosarcoma of spermatic cord
Final Diagnosis
Leiomyosarcoma of spermatic cord
References
[1] Kyratzi I, Lolis E, Antypa E, Lianou MA, Exarhos D (2011) Imaging features of a huge spermatic cord leiomyosarcoma: Review of the literature. World J Radiol 3(4):114-9. doi: 10.4329/wjr.v3.i4.114. PMID: 21532872. PMCID: PMC3084435
[2] Akbar SA, Sayyed TA, Jafri SZH, Hasteh F, Neill JSA (2003) Multimodality Imaging of Paratesticular Neoplasms and Their Rare Mimics. RadioGraphics 23(6):1461–1476. doi: 10.1148/rg.236025174
Case information
| URL: | https://www.eurorad.org/case/18112 |
| DOI: | 10.35100/eurorad/case.18112 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
CECT Abdomen and pelvis axial section in soft tissue window shows a well defined heterogeneously enhancing soft tissue density lesion in left inguinal region with few non enhancing areas – s/o necrosis
Figure 3
CECT Abdomen and pelvis saggital section in soft tissue window shows an elongated spindle shaped heterogeneously enhancing soft tissue density lesion in left inguinal region along left spermatic cord with intra abdominal extension and extending upto the root of scrotum
Figure 4
CECT Abdomen and pelvis axial section in soft tissue window shows left moderate hydrocele and dilated pampiniform plexus of veins
NCCT abdomen pelvis axial section in soft tissue window shows a well defined soft tissue density lesion in left inguinal region with no evidence of hemorrhgae/calcifications
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
CECT Abdomen and pelvis axial section in soft tissue window shows a well defined heterogeneously enhancing soft tissue density lesion in left inguinal region with few non enhancing areas – s/o necrosis
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
CECT Abdomen and pelvis saggital section in soft tissue window shows an elongated spindle shaped heterogeneously enhancing soft tissue density lesion in left inguinal region along left spermatic cord with intra abdominal extension and extending upto the root of scrotum
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
CECT Abdomen and pelvis axial section in soft tissue window shows left moderate hydrocele and dilated pampiniform plexus of veins
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India
Department of Radiodiagnosis, Adichunchangiri institute of medical sciences, Bellur, Karnataka India