Para-testicular Liposarcoma: An Update of the Literature

Less than 200 cases of para-testicular liposarcoma (PTL) have been reported. PTL may present with
painless or painful intra-scrotal or inguinoscrotal mass of long duration or recent onset but the most
common presentation is a painless mass. Para-testicular liposarcomas does mimic various common
intra-scrotal and inguinoscrotal masses, some of which include: inguinal hernia, lipoma, fibroma,
fibrosarcoma, leiomyoma, leiomyosarcoma, rhabdomyosarcoma, various types of testicular tumours
and other non-common intra-scrotal lesions. The symptoms tend to be non-specific. PTLs tend to be
unilateral but bilateral cases have been reported. Radiology imaging would define the features of the
lesion. Fine needle aspiration cytology could establish the diagnosis but the diagnosis tends to be
established by pathology examination of the excised specimen of the tumour which would show
spindled-tumoral cells with atypical features and mitotic activity and lipoblasts. Immunohistochemistry
staining studies of the tumour would exhibit positive staining for MDM2, CDK4, S100 and STAT6. PTL
is treated by trans-inguinal radical orchidectomy ensuring complete excision of the tumour with
tumour-free excision margin plus adjuvant radiotherapy plus / minus adjuvant chemotherapy for
localized disease. For metastatic and advanced lesions, radical trans-inguinal orchidectomy plus
radiotherapy plus chemotherapy should be undertaken. New chemotherapy options need to be
developed to effectively destroy para-testicular liposarcoma tumour cells. All excised innocuous
looking intra-scrotal masses that should be submitted for histopathology examination in order not to
misdiagnose PTL as benign lipoma. Generally the prognosis of localized PTL tends to be good
following radical orchidectomy with complete excision of tumour.