By Dr. Shoaib Hanif
Abstract:
Background:
Paratesticular liposarcoma (PLS) is a rare malignancy, with
giant forms (>10 cm) being exceptionally uncommon. Due to
its rarity, diagnosis is often delayed, and management strategies
remain non-standardized.
Case Presentation:
We report a 59-year-old male presenting with a progressively
enlarging, painless right scrotal swelling over three months.
Imaging with computed tomography revealed a large
heterogeneous soft-tissue mass (10.5×11×15 cm) involving the
right testis, initially suspected to be a teratoma. Surgical
resection with right orchiectomy was performed. Gross
examination revealed a multinodular tan-white paratesticular
mass (15×14×13 cm). Histopathology showed areas of
well-differentiated liposarcoma transitioning to
dedifferentiated components with atypical spindle cells and
frequent mitoses. Immunohistochemistry demonstrated strong
positivity for p16 and MDM2, confirming dedifferentiated
liposarcoma (FNCLCC grade II). Postoperative MRI at three
months showed no residual or recurrent disease, only a
postoperative seroma. The patient remains under close
surveillance.
Conclusion:
Giant dedifferentiated paratesticular liposarcoma is an
exceedingly rare entity that may clinically mimic benign
scrotal conditions. Accurate diagnosis depends on
histopathological and immunohistochemical evaluation,
particularly p16 and MDM2 overexpression. Complete
surgical excision with negative margins remains the mainstay of treatment, while the role of adjuvant therapy remains
uncertain. Long-term follow-up is essential due to the risk of
local recurrence and metastasis.
Keywords:
Paratesticular liposarcoma, Dedifferentiated liposarcoma, p16,
MDM2, Soft tissue sarcoma, Scrotal mass