Well-Differentiated Liposarcoma of the Spermatic Cord Involving Testicular Parenchyma

Abstract

Liposarcomas of the spermatic cord are rare malignant soft-tissue tumors, representing a small fraction of adult sarcomas and an even smaller proportion of para-testicular neoplasms. These tumors often present as slow-growing, painless inguinoscrotal masses and may be mistaken for benign conditions such as inguinal hernias or lipomas. We present the case of a man in his mid-60s who presented with a progressively enlarging right hemi-scrotal mass. Imaging revealed a large fat-containing lesion involving both the spermatic cord and testicular parenchyma, suspicious for fat-containing hernia. The patient underwent right radical inguinal orchiectomy with high ligation of the cord. Histopathologic evaluation demonstrated a well-differentiated liposarcoma without lymphovascular or perineural invasion, with negative surgical margins and no evidence of dedifferentiation. The tumor measured approximately 18 cm in total, involving both cord and testicular tissue. The post-operative course was uneventful, and surveillance imaging has shown no recurrence to date. This case highlights the importance of maintaining a high index of suspicion for malignant etiologies in atypical scrotal masses, the role of radical orchiectomy with wide resection in management, and the necessity for long-term follow-up given the potential for late recurrence even in well-differentiated tumors.