Background: The commonest differentials in a case of inguinal swelling are a hernia, hydrocele, lipoma and lymph nodal mass. However, we may come across some rare causes of inguinal lumps such as leiomyosarcoma. This is a case of an elderly gentleman who presented with a history of a painless, progressively enlarging mass over the right inguinal region which on further investigation was found to be a malignant tumour.
Case presentation: A 70-year-old male patient presented with a mass over the right inguinal region 7 × 7 × 8 cm in size. It was nonreducible and non-trans illuminant. There was no cough impulse either. Sonography of the lump revealed a heterogeneous mass originating in the right inguinal canal queried to be an enlarged lymph node. Computed tomography (CT) scan of the abdomen and pelvis had similar findings. Fine needle aspiration cytology (FNAC) of the lump was inconclusive. The patient underwent an excision biopsy, and intraoperatively a huge fleshy tumour originating from the spermatic cord structures was visualized. Histopathological examination was suggestive of a grade II leiomyosarcoma.
Conclusion: Spermatic cord leiomyosarcoma, although rare, should be kept in mind when dealing with an unusual lump in the cord. This article reviews the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment.
Dattola P, Alberti A, Dattola A, Giannetto G, Basile G, Basile M. Inguino-crural hernias: preoperative diagnosis and postoperative follow-up by high-resolution ultrasonography. A personal experience. Ann Ital Chir. 2002;73(1):65-68.
Rutkow IM. Open versus laparoscopic groin herniorrhaphy: economic realities. Inguinal Hernia Adv or Contraversies. 1994;
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M. Cancer statistics, 2009. CA Cancer J Clin [Internet]. 2009;59(4):225-249.
Rydholm A, Berg NO. Size, site and clinical incidence of lipoma: Factors in the differential diagnosis of lipoma and sarcoma. Acta Orthop. 1983;54(6):929-934.
Toro JR, Travis LB, Hongyu JW, Zhu K, Fletcher CDM, Devesa SS. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the Surveillance, Epidemiology and End Results program, 1978-2001: An analysis of 26,758 cases. Int J Cancer. 2006;119(12):2922-2930.
Wu X, Groves FD, McLaughlin CC, Jemal A, Martin J, Chen VW. Cancer incidence patterns among adolescents and young adults in the United States. Cancer Causes Control [Internet]. 2005;16(3):309-320.
Malkin D, Li FP, Strong LC, Fraumeni JF, Nelson CE, Kim DH, et al. Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms. Science. 1990 Nov 30;250(4985):1233-1238.
Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema. A report of six cases in elephantiasis chirurgica. Cancer. 1948;1(1):64-81.
Gladdy RA, Qin LX, Moraco N, Edgar MA, Antonescu CR, Alektiar KM, et al. Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas? J Clin Oncol. 2010;28(12):2064-2069.
Fong Y, Rosen PP, Brennan MF. Multifocal desmoids. Surgery. 1993;114(5):902-906.
Zahm SH, Fraumeni Jr. JF. The epidemiology of soft tissue sarcoma. Semin Oncol [Internet]. 1997;24(5):504-514.
Dangle P, Basavaraj DR, Bhattarai S, Paul AB, Biyani CS. Leiomyosarcoma of the spermatic cord: case report and literature review. Can Urol Assoc J [Internet]. 2007;1(1):55-58.
Vogelaar FJ, Schuttevaer HM, Willems JM. A patient with an inguinal mass: A groin hernia? Neth J Med. 2009;67(11):399- 400.
Abd Kadir HK, Naik J, Chandrasekar CR. Leiomyosarcoma presenting as “idiopathic” unilateral lower limb lymphoedema. BMJ Case Rep. 2017 Oct;2017.
Soipi S, Vucic M, Ulamec M, Tomas D, Kruslin B, Spajic B. Leiomyosarcoma of the spermatic cord with scalp metastasis: case report and literature review. Coll Antropol. 2014 Jun;38(2):763-766.
Rodríguez D, Olumi AF. Management of spermatic cord tumours: a rare urologic malignancy. Ther Adv Urol [Internet]. 2012;4(6):325-334.
Bochner BH, Hansel DE, Efstathiou JA, Konety B, Lee CT, Mckiernan JM. AJCC Cancer Staging Manual [Internet]. AJCC Cancer Staging Manual. 2017. 758-764 p.
Mehren MV, Randall RL, Benjamin RS, Boles S, Bui MM, Ganjoo KN, et al. Soft tissue sarcoma, version 2.2018: Clinical practice guidelines in oncology. JNCCN J Natl Compr Cancer Netw. 2018;16(5):536-563.
Collin T, Blackburn A V, Milner RH, Gerrand C, Ragbir M. Sarcomas in the groin and inguinal canal - Often missed and difficult to manage. Ann R Coll Surg Engl. 2010;92(4):326–329.
Bell RS, O'Sullivan B, Mahoney JL, Nguygen C, Langer F, Catton C. The inguinal sarcoma: A review of five cases. Can J Surg. 1990;33(4):309-311.
Geelhoed GW, Millar RC, Ketcham AS. Hernia presentation of cancer in the groin. Surgery [Internet]. 1974;75(3):436-441.
Fieber SS, Wolstenholme JT. Primary tumours in inguinal hernial sacs. AMA Arch Surg. 1955 Aug;71(2):254-256.
Montgomery E, Buras R. Incidental liposarcomas identified during hernia repair operations. J Surg Oncol. 1999;71(1):50- 53.
Kassan MA, Munoz E, Laughlin A, Margolis IB, Wise L. Value of routine pathology in herniorrhaphy performed upon adults. Surg Gynecol Obs [Internet]. 1986;163(6):518-522.