Department of Urology, Letterkenny University Hospital, Letterkenny, Ireland.
Cavan General Hospital, Cavan, Ireland.
World J Surg Oncol. 2022 Mar 25;20(1):94. doi: 10.1186/s12957-022-02539-9.
Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology.
A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment.
Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.
原发性软组织肉瘤仅占男性泌尿生殖系统所有恶性肿瘤的 2%。平滑肌肉瘤（LMS）是一种起源于间充质的恶性软组织肿瘤，具有特征性的平滑肌分化。通常，它表现为无痛、坚实、生长缓慢的单侧阴囊肿块。检查包括影像学、肿瘤标志物和组织病理学。
一位 65 岁的绅士，已知患有糖尿病和β地中海贫血特征，被转介到莱特肯尼大学医院的泌尿科门诊。他的主要诉求是左侧腹股沟肿块，该肿块于 1 年前出现，且逐渐增大。据患者自述，起初肿块有轻微的疼痛（局限性），后来就不痛了。他没有报告任何睾丸外伤/感染或尿路感染。他的家族中没有明显的恶性肿瘤病史。临床检查显示腹部柔软松弛，睾丸正常。可触及一个无触痛的 2cm×2cm 边界清楚、可移动、坚实至囊性不可还原的左侧腹股沟阴囊肿块，似乎与精索相连。无法察觉咳嗽冲动。左侧腹股沟超声显示 1.8cm 横径×1.4cm 前后径×1.9cm 矢状位）边界清楚的卵圆形结节性皮下病变，位于左耻骨结节外侧的左上腹股沟区域，呈实性，内部回声不均质，无内部钙化。彩色多普勒评估显示有一些内部血管。
由于其罕见性，LMS 代表了一个管理难题。目前没有治疗的标准方案。我们提出了一个病例，并讨论了迄今为止文献中提供的证据，以帮助识别非常罕见的精索 LMS。
