Leiomyosarcoma of Spermatic Cord: A Rare Paratesticular Neoplasm Case Report

Background: 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, tumour markers and histopathology. Case Presentation: A 65 year old gentleman known Diabetic and Beta-thalassemic trait was referred to Urology OPD at Letterkenny University Hospital. His presenting complaint was left groin lump which appeared one 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 soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well circumscribed, mobile, firm to cystic irrudicible left inguinoscrotal mass, 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. No internal calcification. Some internal vascularity is demonstrated with colour Doppler assessment. Conclusion: 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 identifying LMS of spermatic cord that’s highly unusual.