Leiomyosarcoma of the spermatic cord: A case report and literature review

BACKGROUND: Leiomyosarcoma of the spermatic cord is a rare entity. It presents as a firm and painless intrascrotal mass. For diagnosis radiological methods such as ultrasound, CT or MRI are necessary. Radical orchiectomy is the gold standard of treatment. CASE DESCRIPTION: We reported a one case of a 66-year-old man that he has suffered from a painless hard mass in the right hemiscrotum since three years. Ultrasound revealed a paratesticular mass. Further workup revealed no distant metastasis before surgery. Right radical orchiectomy was performed, the final pathologic examination showed a leiomyosarcoma of the spermatic cord. The patient remained disease-free twelve-month during follow up after surgery. DISCUSSION: Leiomyosarcoma of the spermatic cord is a rare condition, it arises from mesenchymal cells of the spermatic cord and occurs mainly in elderly patients. The diagnosis of spermatic cord leiomyosarcoma is difficult if based only on imaging procedures, it is revealed by histological examination post surgery. No treatment protocol has yet been established for paratesticular leiomyosarcoma due to the rarity of the disease. Standard treatment is radical orchidectomy with high ligation of the spermatic cord. The benefit of adjuvant chemotherapy, radiotherapy, and retroperitoneal lymphadenectomy are not well understood and may differ according to the surgeon's preferences. CONCLUSION: The lack of such cases results in the challenging nature of the diagnosis and treatment of leiomyosarcoma of the spermatic cord. Additional studies are needed to better define optimal management strategies.