Spermatic cord liposarcoma presented as inguinal hernia: case report

Cesar Villa-Jirash, Chief of Endoscopy, Gastro Surgery Department, Hospital Star Médica Lomas Verdes, Naucalpan of Juárez, State of Mexico, Mexico
Iñaki Guasque-Gil, Mexican School of Medicine, Universidad La Salle, Mexico City. Mexico
Nicole Elbjorn-Medina, Mexican School of Medicine, Universidad La Salle, Mexico City. Mexico
Julianne Villa-Trejo, Faculty of Medicine, Universidad de Saint Luke, Mexico City, Mexico

Liposarcomas are the most common malignant soft-tissue tumors in adults, predominantly occurring in the extremities and retroperitoneum. Only 3.6% of these tumors affect the scrotum, including the spermatic cord, testicular tunics, and epididymis. We present the case of a 53-year-old man with iliac fossa pain and increased left scrotal volume. Imaging studies included an inguinal ultrasound under stress and computed tomography (CT), which showed the protrusion of the hernial sac with a well-defined wall and fatty content through the inguinal canal. During laparoscopic hernioplasty, a lipomatous tumor was found in the spermatic cord, leading to testicular lumpectomy and left orchiectomy. Histopathological examination revealed a 13 cm well-differentiated liposarcoma, with no evidence of lymphovascular or perineural invasion. Ultrasound was the first study performed due to its availability and usefulness in diagnosing hernias. However, the atypical appearance of the hernial sac content on ultrasound prompted the performance of a CT scan to better characterize the lesion and rule out other pathologies. In conclusion, spermatic cord liposarcoma is a rare entity that can mimic an inguinal hernia. It is essential to consider it as a differential diagnosis in cases of inguinal hernia. Advanced imaging studies can improve the accuracy of pre-operative diagnosis.

Keywords: Liposarcoma. Inguinal hernia. Spermatic cord. Ultrasonography. Computed tomography.