PMC10172677_01
On physical examination, a lump of about 25 cm x 20 cm in size could be felt in the left scrotum and groin area, with tough texture and clear boundaries.
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F1
The abdominal enhancement CT showed that there was a lumpy uneven density shadow in the left scrotum, and there was fat and soft tissue density shadow In It which was not related with the contents of the abdominal cavity. After enhancement some nodules were slightly enhanced but the remaining enhancement was not found to be obvious [two years ago (A)]. The abdominal enhanced CT showed that there was a lumpy uneven density shadow in the left scrotum again,which was about 18.5 cm x 14 cm in size [now (B)]. MRI enhancement of the pelvic cavity showed irregular mass shadow in left groin and scrotum, lobulated, with some uneven fat signal in the center, about 20 cm x 13 cm x 17 cm in size. After enhancement, it was uneven and patchy, with arc-shaped enhancement,with no obvious changes in fat and cystic parts, clear edges, no connection between the mass and abdominal cavity (C). (The tumor tissue as indicated by arrowheads).
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F2
Soft tissue density nodules were found in the right groin area, but the enhancement was not obvious, and no enlarged lymph nodes were detected retroperitoneum (Figure 2A). The appearance was observed to be similar as observed during the first time, but a slightly larger lymph node was found in the left groin area (Figure 2B). After enhancement, it was uneven and patchy, with arc-shaped enhancement, with no obvious changes in fat and cystic parts, clear edges, no connection between the mass and abdominal cavity, slightly larger lymph nodes in both the groins, and uniform enhancement (Figure 2C).
During the surgery, a tumor with a size of about 20 cm x 18 cm in the groin and scrotum was found, with a tough texture and a cystic mass, which was adhered to the surrounding tissues. After electrocoagulation with Ligsaure and separation, the tumor was completely removed.
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F3
After electrocoagulation with Ligsaure and separation, the tumor was completely removed (Figure 3).
The histopathological findings and immunostaining. Postoperative routine pathology showed that left inguinal scrotal liposarcoma was primarily WDLPS, some of which were MLPS (about 20%), with a tumor size of 26 cm x 17 cm x 13 cm, accompanied by chronic inflammation of three lymph nodes around the tumor, and spindle cell malignant tumor of left femoral vein lymph nodes, which was considered as liposarcoma (A). On immunostaining, the tumor cells were focally positive for S-100 (B), Des (C), Vim (D) and Ki-67(5%) (E) and negative for CD34, Actin, CK, SMA, catenin-beta and STAT6. (A x 100 magnifcation, B-E x 200 magnifcation).
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F4
Postoperative routine pathology showed that left inguinal scrotal liposarcoma was primarily WDLPS, some of which were MLPS (about 20%), with a tumor size of 26 cm x 17 cm x 13 cm, accompanied by chronic inflammation of three lymph nodes around the tumor, and spindle cell malignant tumor of left femoral vein lymph nodes, which was considered as liposarcoma (Figure 4A). Immunohistochemistry suggested CD34(-), S-100(scattered+) (Figure 4B), Des(partial+) (Figure 4C), Actin(-), CK(-), Vim(+) (Figure 4D), Ki-67(5%) (Figure 4E), P53(+-), SMA(-), Myogenin(+-), catenin-beta(-), STAT6(-).