Dedifferentiated Liposarcoma of the Spermatic Cord: A Case Report and Review of the Literature.

Spermatic cord liposarcomas are rare malignant neoplasms with no established level-one evidence-based treatment guidelines. Well-differentiated liposarcomas (WDL) lack metastatic potential but can transform into dedifferentiated liposarcomas (DDL), which are more aggressive. Due to the rarity of these tumors, treatment recommendations are primarily based on retrospective studies and extrapolated data from extremity sarcomas. We report a case of a DDL managed with radical orchiectomy and en bloc resection, along with a literature review on spermatic cord liposarcomas, focusing on imaging, histopathology, and treatment strategies. Imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), aid in tumor characterization, while histopathological examination remains the gold standard for diagnosis. Surgical management prioritizes R0 resection, as incomplete excision is associated with high recurrence rates. The role of adjuvant therapy remains controversial, with limited evidence supporting its routine use. In our case, complete resection with negative margins was achieved, and clinical follow-up was chosen over adjuvant treatment. Given the aggressive nature of high-grade liposarcomas and their tendency for local recurrence, wide surgical excision with negative margins remains the primary treatment. The role of adjuvant chemotherapy and radiotherapy is unclear and may be considered in high-risk cases. Further research is needed to establish standardized treatment protocols.