Bouckaert Andreas, Bamelis Bruno, Dedrye Lieven, Sohier Stefan, Verbrugghe Anneleen, Fierens Johan
Department of Surgery and Urology, Jan Yperman Hospital, Ieper, Belgium.
Acta Chir Belg. 2025 Jun;125(3):164-169. doi: 10.1080/00015458.2025.2481696. Epub 2025 Apr 7.
Giant dedifferentiated liposarcomas of the spermatic cord are a rare and aggressive entity. Both large size and dedifferentiated liposarcoma histology implicate a poorer prognosis with a high risk of recurrence and metastasis.
This is a retrospective case report. We describe a 58-year-old patient who presented with a hemodynamic collapse, caused by a high gastro-intestinal bleeding. A giant inguinoscrotal mass challenged the diagnostic path.
A combined abdominal and scrotal approach was used to remove the giant mass (26 × 15 × 11 cm, 1.617 kg) en bloc with the right testicle and spermatic cord. Pathological examination showed a giant dedifferentiated liposarcoma (FNCLCC grade 2), with a microscopically complete resection. Follow-up at 24 months showed no locoregional recurrence or distant metastasis.
Radical surgery remains the cornerstone of treatment for retroperitoneal liposarcoma. Microscopically complete resection is an important positive prognostic indicator for risk of recurrence. Rigorous follow up is necessary, considering the high risk for recurrence. This patient illustrates the challenge of not allowing the giant inguinoscrotal mass to draw away all attention from a life-threatening high gastro-intestinal bleeding.
精索巨大去分化脂肪肉瘤是一种罕见且侵袭性强的疾病。肿瘤体积大以及去分化脂肪肉瘤的组织学特征均提示预后较差，复发和转移风险高。
这是一篇回顾性病例报告。我们描述了一名58岁患者，因严重胃肠道出血导致血流动力学崩溃。一个巨大的腹股沟阴囊肿物给诊断带来了挑战。
采用经腹和阴囊联合入路，将巨大肿物（26×15×11cm，1.617kg）与右侧睾丸及精索整块切除。病理检查显示为巨大去分化脂肪肉瘤（法国国立癌症中心软组织肿瘤分级2级），镜下切除完整。24个月的随访显示无局部复发或远处转移。
根治性手术仍然是腹膜后脂肪肉瘤治疗的基石。镜下完整切除是复发风险的重要阳性预后指标。鉴于复发风险高，严格的随访是必要的。该患者说明了不能让巨大的腹股沟阴囊肿物转移对危及生命的严重胃肠道出血的所有注意力这一挑战。
