Matsui Yuki, Yanagida Wahei, Kishi Hirotaka, Morita Jun, Fukagai Takashi
Department of Urology, Showa University School of Medicine, Tokyo, JPN.
Cureus. 2025 Mar 8;17(3):e80264. doi: 10.7759/cureus.80264. eCollection 2025 Mar.
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.
精索脂肪肉瘤是罕见的恶性肿瘤，目前尚无一级循证医学治疗指南。高分化脂肪肉瘤（WDL）无转移潜能，但可转变为侵袭性更强的去分化脂肪肉瘤（DDL）。由于这些肿瘤罕见，治疗建议主要基于回顾性研究以及从肢体肉瘤外推的数据。我们报告一例通过根治性睾丸切除术和整块切除治疗的DDL病例，并对精索脂肪肉瘤进行文献综述，重点关注影像学、组织病理学和治疗策略。磁共振成像（MRI）和计算机断层扫描（CT）等成像技术有助于肿瘤特征的判定，而组织病理学检查仍是诊断的金标准。手术治疗优先考虑R0切除，因为不完全切除与高复发率相关。辅助治疗的作用仍存在争议，支持其常规使用的证据有限。在我们的病例中，实现了切缘阴性的完整切除，选择临床随访而非辅助治疗。鉴于高级别脂肪肉瘤的侵袭性及其局部复发倾向，切缘阴性的广泛手术切除仍是主要治疗方法。辅助化疗和放疗的作用尚不清楚，高危病例可考虑使用。需要进一步研究以建立标准化治疗方案。
