A 26-year-old otherwise healthy male was referred for evaluation of a left paratesticular mass. The mass caused no discomfort or local symptoms; it came to the patient’s attention as a painless firm mass that enlarged over the course of six months. On physical exam, a 6-cm oval-shaped paratesticular mass distinct from the left testis was palpated. A scrotal ultrasound was performed initially, which confirmed an extratesticular mass 6.1 × 5.5 × 4.3 cm, likely a paratesticular tumour arising from the left spermatic cord (). The mass was predominately hypoechoic with scattered hyperechoic foci and increased vascularity. The testes and epididymi were normal in size and echogenicity bilaterally.
Scrotal ultrasound (transverse view) demonstrating extratesticular mass arising from L spermatic cord, with (a) predominantly hypoechoic appearance with scattered hyperechoic foci and (b) increased vascularity demonstrable on color flow Doppler.
Testis tumour markers were all normal [alpha-fetoprotein (AFP) 2.1, lactate dehydrogenase (LDH) 566, human chorionic gonadotrophin (HCG) <2.0]. A magnetic resonance imaging of the abdomen and pelvis further characterized this mass as a 4.7 × 6.2 × 5.9 cm tumour arising from the spermatic cord (). The mass demonstrated marked avid enhancement on post-contrast images, suggestive of a spermatic cord sarcoma. No evidence of pelvic or retroperitoneal lactic acid dehydrogenase was seen.
Fig. 2 Magnetic resonance imaging demonstrating tumour 4.7×6.2×5.9 cm arising from left spermatic cord. (a) coronal view showing marked avid enhancement on post-contrast images, (b) sagittal view of heterogenous mass with prominent feeding vessels (more ...)
A left inguinal exploration was performed, during which the left testis and mass were delivered separately into the surgical field. On gross examination, the mass appeared well-encapsulated, with a smooth surface free of adhesions or tumour extension, allowing us to easily resect it from the ipsilateral scrotal wall and spermatic cord.
On histological examination, the cut surface of the mass was pink-tan, homogeneous and fleshy in appearance without any hemorrhage or necrosis. Microscopy () revealed a 7.5-cm solitary fibrous tumour (lipomatous hemangiopericytoma), with minimal proliferative activity as seen by KI-67 <5.0% and 0/10 mitotic figures observed per high power field. Immunohistochemistry was as follows: CD34 +, BCL-2 +, SMA -, desmin -, S100 protein -. On the basis of these histopathologic and immunohistochemical findings, the diagnosis of a paratesticular solitary fibrous tumour was made.
Hematoxylin and eosin stain demonstrating bland spindle cell tumour with vascular spaces, some showing “staghorn” configuration.