Incidental finding of giant dedifferentiated liposarcoma of the spermatic cord: case report and review of the literature.

Introduction: 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.

Methods: 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.

Results: A combined abdominal and scrotal approach was used to remove the giant mass (26x15x11cm, 1.617kg) 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.

Conclusion: 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.