Scrotal liposarcoma – a rare extratesticular tumour

Scrotal and inguinal masses are common patient complaints that prove diagnostically challenging due to the multiple anatomic structures found in the confined space of the scrotum. History and adequate examination is the cornerstone in diagnosing scrotal pathology. Ultrasonography is the principle radiologic study used to evaluate scrotal masses. This can locate the site of a mass, and differentiate between solid and cystic lesions. The Doppler feature can also be used to evaluate blood flow. Occasionally CT or MRI is used if ultrasound is inconclusive, and usually precedes scrotal exploration. Scrotal masses can be testicular or paratesticular. Paratesticular masses are usually benign, with adenomatoid tumours being the most common, representing 30% of paratesticular masses and 77% of benign tumours arising from the epididymis. They usually occur in the 20– 40-year age group but can present at any age, are 0.5–5 cm in size, and slow-growing. Papillary cystadenomas and leiomyomas account for most of the other benign solid tumours. Primary malignancies of the epididymis or paratesticular structures are extremely rare in adults. These are adenocarcinomas, and sarcomas including rhabdomyosarcoma, leiomyosarcomas and liposarcomas. Liposarcoma is the second most common soft tissue tumour in adults, with an incidence ranging from 9.8–16.0%. According to the 2002 World Health Organization (WHO) histological classification of tumours, liposarcoma can be divided into five categories: atypical lipomatous tumour/well-differentiated; dedifferentiated; myxoid; pleomorphic; and mixed-type liposarcoma. Liposarcoma of the spermatic cord is however a rare condition, representing about 7% of paratesticular sarcomas.