Date of Presentation:9/20/2021

Attending pathologist: Anil Parwani, MD, PhD, MBA

Presented by: Nada Shaker, MD

Prepared by: Nada Shaker, MD

Organ:Scrotum

HISTORY:

A male in his 50s presented for evaluation and management of a painless right testicular mass. The patient initially noticed a painless hemi-scrotal swelling that started two months ago. The patient denied any abdominal or back pain. No significant urinary problems. No gynecomastia, leg swelling or calf pain.

Initial evaluation with US scrotum and testicles revealed a large mass inferior to the right testis that is indeterminate. Recommend correlation with CT pelvis is mandated. CT pelvis with contrast revealed indeterminate large right extra testicular mass within the scrotum, bilateral fat-containing inguinal hernias and a large right hydrocele. The primary concern was malignancy. A right radical inguinal orchiectomy was performed.

Serologic testing demonstrated AFP tumor marker of 3.5 ng/mL, Beta HCG <2.6 mIU/Ml and LD Total of 141 U/L

GROSS:

Opening of the specimen reveals a 9.0 x 8.8 x 7.5 cm, well-defined, rubbery, homogeneous, fibrotic, tan-white Para testicular mass that abuts the possible spermatic cord margin and tunica vaginalis.

Sectioning of the mass reveals mass involvement of the spermatic cord and adjacent adipose tissue with no involvement of the testis proper or epididymis.

No hemorrhage, necrosis, or calcification is identified within the mass.

What is the most likely diagnosis?

  1. Embryonal rhabdomyosarcoma
  2. Paratesticular Liposarcoma, dedifferentiated
  3. Undifferentiated pleomorphic sarcoma
  4. Myxofibrosarcoma
  5. Fibromatosis
Paratesticular Liposarcoma, dedifferentiated