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Liposarcoma of the Scrotum
LIP0SARC0i\1A OF THE SCROTUl\I JOHN I. WALLER From the Departm.ent of Urology, The Hertzler Clinic ancl The Hertzler Research Foundation, Halstead, Kans.
According to Herbut, tumors listed as sarcoma of the scrotum are extremely uncommon. Up to 1952 he had found only ::l cases recorded. The 3 cases he listed were those of Corn and Pierce in 1931, who reported a spindle cell sarcoma; that of Thompson, in Hl39; and Higgins and Warden, in 1949. This lltttcr case was a spindle cell sarcoma. A. case of neurofibrosarcoma of the scrotum was recorded Nation and Potampa in 1944. In November 19.58 Lane reported a fibrosarcoma of the scrotum. He stated that fibrosarcoma is the commonest of the soft tissue sarcomas. He felt that all of these tumors are invasive and the capsule, ll'hich is often present, is not a true barrier because the tumor cells may invade it. He mfrisecl wide local excision and irradiation. Livermore, in 1933, reported a lipomyxofibrorna of the scrotum and in 1948 reported a lipoma of the scrotum. Pearlman and }\lackey reported an intrascrotal rbabdomvosarcorna in J\Iarch 1960. Their patient remai;,rnd asymptornatic 1 year after local excision. Dreyfuss and Goodsitt reported 4 tumors of the sperrnatic cord and one of these was a liposarcoma. They stated that the liposarcomas are probably the mildest in activity as to recurrence and tendency to metastasize and felt that radical treatment was not indicated in their case. Kretschmer, in 1946, stutecl that little has appeared in the literature regarding tumors of the scrotum due to the fact that they are very uncommon. He felt that many authors who did report on tumors of the scrotum had included tumors of the testicle, testicular tunica and the epididymis and neoplasms from the cord. He l'cported a pure fibroma of tlie scrotum. Lombardi in 19;34 reported a fibrolipoma of the scrotum. The liµosarcoma here reported was a tumor of the scrotal wall and was not in any way attached to the cord, testicle, or epididrmis, these structures all being normal.
CASE REPOHT
N. G. H., Halstead Hospital N'o. 41324, a, white man aged 58 years, was admitted 28, 1960, because of a painless mass 3 rnonth.c, in duration in the left scrotal area. He gan, 1w history of trauma to the scrotum. I-k hacl- uoti<>ed that the mass was grm,-ing largN during the ?receding :3 weeks. The remainder of his pt:escnt illness and past, family and social history were negative. Physical examination showed a rather obese white man, who did not appear acutely ill. Th,: blood pressure was 132/86, respiration lG JJP!' minute, pulse 74 per minute and tempcratuff 98.6F. The physical findings were normal c•:-;ccpt that the patient was somewhat obese, weighing 192 pounds, and had a mass on the left sick of the scrotum that was non-tenclcr, awl felt as it was part of the right scrotal wall. The tc,stic:[e, epicliclymis and cord seemed to be cutircl_\' sepa .. rate from the mass. A tentative diagnosis of tumor of the: left scrotal wall was made and operation ach-is,·cl On August 30, 1960, an incision was made thrmwh the scrotum above the mass, the tumor ,, and removed. A. frozen section of the tumor wa.~
Accepted for publication l\fa.v 31, H)61. 139
FIG. l. Liposarcoma of scrotum. Lobula((•d }'ellow tumor has ?;ross appearance or benign hpoma.
140
JOHN I. WALLER
Fm. 2. Differentiated liposarcoma. A, tumor is composed in part of adult fat cells, but immature lipoblasts are present. (X150.) B, high magnification of bizarre lipoblasts with giant nuclei. (X450.) C, another area shows huge lipoblasts with lipoid vacuoles. requested, and Dr. C. A. Hellwig of the Pathology Department, The Hertzler Clinic, reported liposarcoma. Following this, an extensive excision of all lipoid tissue was made~extending into the groin and toward the base of the penis. The skin of the scrotum attached to the tumor was also removed. The wound was then closed with a small rubber drain in place. The patient made an uneventful recovery and was dismissed from the hospital on September 8, 1960. Pathological report: The lobulated tumor was soft, with a smooth surface; it measured 6 by 4 by 2 cm. Cross-section showed yellow tissue arranged in lobules. No myxomatous or opaque whitish areas could be recognized. J\/Iicroscopic examination: In the paraffin sections stained with hematoxylin and eosin, the larger part of the tumor appeared to be composed of adult fat cells. Intermingled with these fat cells were more cellular areas with immature lipoblasts. Bizarre giant cells with foamy cytoplasm and huge pyknotic nuclei betrayed the true nature of the neoplasm. Some signet ring cells ,sere present with a single, large lipoid vacuole in the cytoplasm pressing upon the nucleus. No myxomatous areas with stellate nuclei were seen. Diagnosis: Differentiated liposarcoma (C. A. Hellwig).
TREATMENT
The treatment of these tumors is total excision. When totally excised the prognosis is good. However, even lipomas of the scrotum may recur. Bonney reported a recurrence 19 years after the original operation. Menvillc reported a primary myxoma of the scrotum in 1934 and advised free and total excision because this tumor has a tendency to reappear and is considered locally malignant. SUMMARY
A case of liposarcoma of the scrotum is reported. Primary tumors of the scrotum are unusual and sarcoma of the scrotum is quite rare.
327 Chestnut St., Halstead, Kans. REFERENCES BONNEY, C. W.: Lipomatous tumors of the scrotum. Urol. & Cutan. Rev., 34: 299-301, 1930.
CoRN, E. AND PIERCE, L. W.: Sarcoma of the scrotum; case. Urol. & Cutan. Rev., 35: 364, 1931.
DREYFUSS, W. AND GooDSITT, E.: Tumors of the spermatic cord. J. Urol., 84: 658-665, 1960. HERBUT, P. A.: Urological Pathology. Philadelphia: Lea & Febiger, 1952, vol. 2, p. 1216. HIGGINS, C. C. AND WARDEN, J. G.: Cancer of the scrotum. J. Urol., 62: 250-256, 1949.
LIPOSARCOMA OF SCROTUM
KRETSCHMER, H. L.: Fibroma of the scrotum. J.A.M.A., 132: 143-144, 1946. LIVERMORE, G. R.: Lipoma of the scrotum: Case report. J. Urol., 60: 153-155, 1948. LIVERMORE, G. R.: Lipomyxofibroma of the scrotum. Brit. J. Urol., 5: 49-54, 1933. LANE, D.: Fibrosarcoma of scrotum. Austral. & New Zeal. J. Surg., 28: 139, 1958. LOMBARDI, R.: Rare case of fibrolipoma of the scrotum. Riforma med., 50: 563-564, 1934.
141
MENVILLE, J. G.: Primary myxoma of the scrotum. J. Urol., 32: 125-129, 1934. NATION, E. F. AND PoTAMPA, P. B.: Unusual scrotal tumor: Report of case of neurofibrosarcoma. J. Urol., 51: 174-177, 1944. PEARLMAN, C. K. AND MACKEY, J. F., JR.: Intrascrotal rhabdomyosarcoma: Case report. J. Urol., 83: 303-304, 1960. THOMPSON, H. R.: Extratesticulr scrotal sarcoma; case. Brit. J. Surg., 27: 169-172, 1939.
If you plan to attend the ANNUAL MEETING of the AMERICAN UROLOGICAL ASSOCIATION, INC. in Philadelphia (May 14-17, 1962), please preregister early. Pre-Registration forms will he found in the advertising section, p. 4, in the front part of this journal. Merely pull out the Pre-Registration form, fill it in, and mail it.
According to Herbut, tumors listed as sarcoma of the scrotum are extremely uncommon. Up to 1952 he had found only ::l cases recorded. The 3 cases he listed were those of Corn and Pierce in 1931, who reported a spindle cell sarcoma; that of Thompson, in Hl39; and Higgins and Warden, in 1949. This lltttcr case was a spindle cell sarcoma. A. case of neurofibrosarcoma of the scrotum was recorded Nation and Potampa in 1944. In November 19.58 Lane reported a fibrosarcoma of the scrotum. He stated that fibrosarcoma is the commonest of the soft tissue sarcomas. He felt that all of these tumors are invasive and the capsule, ll'hich is often present, is not a true barrier because the tumor cells may invade it. He mfrisecl wide local excision and irradiation. Livermore, in 1933, reported a lipomyxofibrorna of the scrotum and in 1948 reported a lipoma of the scrotum. Pearlman and }\lackey reported an intrascrotal rbabdomvosarcorna in J\Iarch 1960. Their patient remai;,rnd asymptornatic 1 year after local excision. Dreyfuss and Goodsitt reported 4 tumors of the sperrnatic cord and one of these was a liposarcoma. They stated that the liposarcomas are probably the mildest in activity as to recurrence and tendency to metastasize and felt that radical treatment was not indicated in their case. Kretschmer, in 1946, stutecl that little has appeared in the literature regarding tumors of the scrotum due to the fact that they are very uncommon. He felt that many authors who did report on tumors of the scrotum had included tumors of the testicle, testicular tunica and the epididymis and neoplasms from the cord. He l'cported a pure fibroma of tlie scrotum. Lombardi in 19;34 reported a fibrolipoma of the scrotum. The liµosarcoma here reported was a tumor of the scrotal wall and was not in any way attached to the cord, testicle, or epididrmis, these structures all being normal.
CASE REPOHT
N. G. H., Halstead Hospital N'o. 41324, a, white man aged 58 years, was admitted 28, 1960, because of a painless mass 3 rnonth.c, in duration in the left scrotal area. He gan, 1w history of trauma to the scrotum. I-k hacl- uoti<>ed that the mass was grm,-ing largN during the ?receding :3 weeks. The remainder of his pt:escnt illness and past, family and social history were negative. Physical examination showed a rather obese white man, who did not appear acutely ill. Th,: blood pressure was 132/86, respiration lG JJP!' minute, pulse 74 per minute and tempcratuff 98.6F. The physical findings were normal c•:-;ccpt that the patient was somewhat obese, weighing 192 pounds, and had a mass on the left sick of the scrotum that was non-tenclcr, awl felt as it was part of the right scrotal wall. The tc,stic:[e, epicliclymis and cord seemed to be cutircl_\' sepa .. rate from the mass. A tentative diagnosis of tumor of the: left scrotal wall was made and operation ach-is,·cl On August 30, 1960, an incision was made thrmwh the scrotum above the mass, the tumor ,, and removed. A. frozen section of the tumor wa.~
Accepted for publication l\fa.v 31, H)61. 139
FIG. l. Liposarcoma of scrotum. Lobula((•d }'ellow tumor has ?;ross appearance or benign hpoma.
140
JOHN I. WALLER
Fm. 2. Differentiated liposarcoma. A, tumor is composed in part of adult fat cells, but immature lipoblasts are present. (X150.) B, high magnification of bizarre lipoblasts with giant nuclei. (X450.) C, another area shows huge lipoblasts with lipoid vacuoles. requested, and Dr. C. A. Hellwig of the Pathology Department, The Hertzler Clinic, reported liposarcoma. Following this, an extensive excision of all lipoid tissue was made~extending into the groin and toward the base of the penis. The skin of the scrotum attached to the tumor was also removed. The wound was then closed with a small rubber drain in place. The patient made an uneventful recovery and was dismissed from the hospital on September 8, 1960. Pathological report: The lobulated tumor was soft, with a smooth surface; it measured 6 by 4 by 2 cm. Cross-section showed yellow tissue arranged in lobules. No myxomatous or opaque whitish areas could be recognized. J\/Iicroscopic examination: In the paraffin sections stained with hematoxylin and eosin, the larger part of the tumor appeared to be composed of adult fat cells. Intermingled with these fat cells were more cellular areas with immature lipoblasts. Bizarre giant cells with foamy cytoplasm and huge pyknotic nuclei betrayed the true nature of the neoplasm. Some signet ring cells ,sere present with a single, large lipoid vacuole in the cytoplasm pressing upon the nucleus. No myxomatous areas with stellate nuclei were seen. Diagnosis: Differentiated liposarcoma (C. A. Hellwig).
TREATMENT
The treatment of these tumors is total excision. When totally excised the prognosis is good. However, even lipomas of the scrotum may recur. Bonney reported a recurrence 19 years after the original operation. Menvillc reported a primary myxoma of the scrotum in 1934 and advised free and total excision because this tumor has a tendency to reappear and is considered locally malignant. SUMMARY
A case of liposarcoma of the scrotum is reported. Primary tumors of the scrotum are unusual and sarcoma of the scrotum is quite rare.
327 Chestnut St., Halstead, Kans. REFERENCES BONNEY, C. W.: Lipomatous tumors of the scrotum. Urol. & Cutan. Rev., 34: 299-301, 1930.
CoRN, E. AND PIERCE, L. W.: Sarcoma of the scrotum; case. Urol. & Cutan. Rev., 35: 364, 1931.
DREYFUSS, W. AND GooDSITT, E.: Tumors of the spermatic cord. J. Urol., 84: 658-665, 1960. HERBUT, P. A.: Urological Pathology. Philadelphia: Lea & Febiger, 1952, vol. 2, p. 1216. HIGGINS, C. C. AND WARDEN, J. G.: Cancer of the scrotum. J. Urol., 62: 250-256, 1949.
LIPOSARCOMA OF SCROTUM
KRETSCHMER, H. L.: Fibroma of the scrotum. J.A.M.A., 132: 143-144, 1946. LIVERMORE, G. R.: Lipoma of the scrotum: Case report. J. Urol., 60: 153-155, 1948. LIVERMORE, G. R.: Lipomyxofibroma of the scrotum. Brit. J. Urol., 5: 49-54, 1933. LANE, D.: Fibrosarcoma of scrotum. Austral. & New Zeal. J. Surg., 28: 139, 1958. LOMBARDI, R.: Rare case of fibrolipoma of the scrotum. Riforma med., 50: 563-564, 1934.
141
MENVILLE, J. G.: Primary myxoma of the scrotum. J. Urol., 32: 125-129, 1934. NATION, E. F. AND PoTAMPA, P. B.: Unusual scrotal tumor: Report of case of neurofibrosarcoma. J. Urol., 51: 174-177, 1944. PEARLMAN, C. K. AND MACKEY, J. F., JR.: Intrascrotal rhabdomyosarcoma: Case report. J. Urol., 83: 303-304, 1960. THOMPSON, H. R.: Extratesticulr scrotal sarcoma; case. Brit. J. Surg., 27: 169-172, 1939.
If you plan to attend the ANNUAL MEETING of the AMERICAN UROLOGICAL ASSOCIATION, INC. in Philadelphia (May 14-17, 1962), please preregister early. Pre-Registration forms will he found in the advertising section, p. 4, in the front part of this journal. Merely pull out the Pre-Registration form, fill it in, and mail it.