Cancer Res Treat.  2012 Sep;44(3):210-214.

A Case of Paratesticular Leiomyosarcoma Successfully Treated with Orchiectomy and Chemotherapy

• Ko BS
• Kim NY
• Ryu AJ
• Kim DS
• Gong SJ
• Kim DK
• Son HJ
• Lee JA

Abstract

A 50-year-old male patient presented with a right scrotal mass that had been growing rapidly for more than one year. A heterogeneous enhancing right scrotal mass (12x9 cm) with para-aortic and peri-caval lymphadenopathies was found on abdominal computed tomography (CT). Right orchiectomy was performed and the gross finding had shown intact testis with a well-defined, huge, whitish solid mass adjacent to the testis. According to pathology, the mass was characterized as a leiomyosarcoma, grade 3 (by National Cancer Instituted [NCI] system). Therefore, the diagnosis was stage III, grade 3 paratesticular leiomyosarcoma. The patient underwent additional systemic chemotherapy using ifosfamide and adriamycin. After nine cycles of chemotherapy, positron emission tomography-CT was performed and no FDP uptake was observed. The patient has been followed up for 12 months after systemic chemotherapy, and he has maintained a complete response. We report here on a rare case of paratesticular leiomyosarcoma treated successfully with orichiectomy and additional systemic chemotherapy.

Keyword

Leiomyosarcoma; Orchiectomy; Chemotherapy

MeSH Terms

Doxorubicin
Electrons
Formycins
Humans
Ifosfamide
Leiomyosarcoma
Male
Middle Aged
Orchiectomy
Ribonucleotides
Testis
Doxorubicin
Formycins
Ifosfamide
Ribonucleotides

Figure

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  Fig. 1 (A, D) Abdominal enhanced computed tomography (CT) at the time of the first diagnosis. (A) A huge heterogeneous enhancing mass (12×9 cm) in the right scrotum. (D) Multiple enlarged (about 2 cm) lymphadenopathies at the para-aortic and peri-caval areas (arrows). (B, E) Abdominal enhanced CT after four cycles of chemotherapy. (B) The orchiectomy site showing no evidence of tumor recurrence. (E) The lymphadenopathy has decreased in size to less than 1 cm (circle). (C, F) Whole body positron emission tomography-CT after nine cycles of chemotherapy. (C) Coronal view without fructose-1,6-bisphosphate (FDP) uptake. (F) Axial view showing the significant decrease in size of lymph nodes without FDP uptake.

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  Fig. 2 Gross findings. A well-defined huge solid mass (13×10 cm) is seen adjacent to the testis. The testis is of normal size and is grossly intact. The tumor is completely separated from the testis and has a whitish tan, solid and trabeculated cut surface.

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  Fig. 3 Microscopic findings. (A) The lower power view shows tumor cells arranged in a whorled or intersecting pattern and a partially necrotic portion is identified (H&E staining, ×12.5). (B) The tumor shows high atypism and is composed of spindle cells, indicating their probable mesenchymal origin (H&E staining, ×100). (C) The high power view displays the nuclear pleomorphism and many mitoses of the tumor cells (H&E staining, ×400). (D) Immunohistochemical staining shows diffuse and strong positivity for smooth muscle actin (×200).

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