PMC10410441_01
(A, B) Huge left inguinoscrotal testicular tumor. It was a hard mass, non-tender, non-pulsatile, and not expanding with a cough impulse.
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On clinical examination, there was a huge inguinal scrotum tumor that was palpable up to the umbilical level, measuring approximately 50 x 20 x 10 cm ( Figure 1 ).
(A) Coronal view of contrast-enhanced computed tomography (CECT) scan showed huge left testicular tumor extending from scrotum until intraabdominal up to umbilical level with a length of 43 cm. (B) Coronal view of CECT scan showed the testicular tumor encasing the left external iliac artery. (C) Axial view of CECT scan showed close proximity to left psoas muscle and anterior abdominal wall. (D) Axial view of CECT scan showed close proximity to the descending colon.
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There was no lymph node involvement and no distant metastasis reported ( Figure 2 ).
(A) Laparoscopic port incision; 2 x 12 mm camera ports were inserted at supraumbilical and right paramedian region and 2 x 5 mm working ports were inserted at the left upper quadrant. (B) Transinguinal incision for excision of the testicular tumor. Drain was inserted into the scrotum.
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Then, we continued the surgery via inguinal incision to complete the tumor mobilization from the scrotum and delivered the tumor en bloc through inguinal incision ( Figure 3 ).
(A) Gross specimen of the left paratesticular tumor measured 50 x 20 x 10 cm. (B) The left testicular tumor weighed 4.1 kg on the weighing scale.
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The tumor weighed 4,100 g ( Figure 4 ), and it is the largest described to date in literature.
Histopathological features of paratesticular dedifferentiated liposarcoma with rhabdomyosarcomatous component. (A) Well-differentiated tumor showing atypical spindle cells (H&E, x200). Inset shows lipoblasts (H&E, x400). (B) Dedifferentiated tumor is cellular and resembles pleomorphic spindle cells with hyperchromatic nuclei and inconspicuous nucleoli (H&E, x400). (C) In areas, small round blue malignant cells are seen (H&E, x400). (D) Focal rhabdomyosarcomatous elements are observed (H&E, x400), in which they are immunopositive for (E) desmin (desmin, x400) and (F) myoD1 (myoD1, x400).
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Focal rhabdomyosarcomatous differentiation accounting for approximately 20% of the tumor was also observed ( Figure 5 ).
Disease timeline from its presentation to the treatment of care.
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After extensive discussion, the patient agreed to undergo chemotherapy and is currently receiving single-agent doxorubicin treatment for the metastatic dedifferentiated paratesticular liposarcoma ( Figure 6 ).