Subcutaneous Scrotal Leiomyosarcoma Presenting as Pedunculated Multi-locular Cystic Growth in the Scrotum Mimicking a Sebaceous Cyst: A Case Report and Review of the Literature

Background Scrotal leiomyosarcomas are extremely rare and hence the biological behaviour of these rare tumours may not be known by most medical practitioners. To the knowledge of the authors about 37 cases of leiomyosarcoma of scrotum have so far been reported. Aims To report a case of leiomyosarcoma of scrotum To review the literature on leiomyosarcomas of scrotum Case Report A 66-years-old man underwent a day case procedure excision under local anaesthesia of a pedunculated scrotal lump which had been annoying him for a number of years. Clinically, the lump was considered to be a benign lump which pre-operatively was thought to have features of a sebaceous cyst. However during the procedure of excision of the lump it was felt that the lump was firm and was most likely a fibroma. Based upon the fact that the lump was considered to be benign the patient was discharged from follow-up only to be referred but by his General Practitioner in case he developed any post-operative wound problems. Histology of the excised scrotal lump was consistent with that of scrotal leiomyosarcoma. At follow-up, 29 months pursuant to excision of the lump, there was no evidence of recurrence. Literature review indicated that: -Only 37 cases of scrotal leiomyosarcoma had previously been reported. -Wide excision of scrotal leiomyosarcomas with a clear margin of at least 10 mm was associated with better outcome in comparison with margin involvement or tumour clear margin which was less than 10 mm. -Late local recurrence and distant metastases occurred in some cases therefore long-term follow-up was recommended. -The problem of incomplete resection or margin involvement occurs and in such situations re-excision should be performed. -Chemotherapy may be effective in selected group of patients who have refused surgery. -Radiotherapy and chemotherapy have been used in some cases but there is no universal agreement on their use as adjuvant therapy in all cases in the treatment of leiomyosarcoma of scrotum. -Radiotherapy / chemotherapy should supplement and should not substitute complete excision of the lesion. Conclusion Leiomyosarcoma of scrotum is rare and this should be treated by excision of the lesion with a clear margin of at least 10 mm. There is a place for Adjuvant therapy (radiotherapy / chemotherapy) in some cases.