title: Adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of spermatic cord leiomyosarcoma.
abstract: BACKGROUND
  The aim of this report is related to adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of the spermatic cord leiomyosarcoma. Primary paratesticular tumors are rare, only accounting for 7% to 10% of all intrascrotal tumors. In adults, more than 75% of these lesions arise from the spermatic cord, 20% being leiomyosarcoma. Tumor grade, stage, histologic type, and lymph node involvement are independently predictive of prognosis.
  
  
  RESULTS
  The case report concerns a 81-year-old man presented with a 3-year history of painless lump in the right hemiscrotum. Scrotal examination demonstrated a 5.1-cm, firm-to-hard mass attached to the spermatic cord. Scrotal ultrasound scan revealed a heterogeneous mass separate from the testis. He was treated with an radical orchi-funicolectomy. Histologically the lesion is composed of spindled cells with often elongated, blunt-ended nuclei and variably eosinophilic cytoplasm. Areas with pleomorphic morphology are present. The level of mitotic activity is equal to 3/10 HPF in the areas with spindle cell morphology and to 12/10 HPF in the areas with pleomorphic morphology. The final diagnosis was that a leiomyosarcoma of the spermatic cord, with grade 1 and grade 2 areas, stage pT2b cN0 and cM0. The patient has been followed up for 3 months with CT scans and shows no signs of recurrence.
  
  
  CONCLUSIONS
  Spermatic cord leiomyosarcoma, although rare, should be one of the first differential diagnoses for a firm-to-hard lump in the cord. Apart from radical orchi-funicolectomy, there has been added benefit of adjuvant radiotherapy to prevent any loco-regional lymph node recurrence.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1613030331125632.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Galosi
authors.forename: Marina
authors.initials: M
authors.lastname: Scarpelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Mazzucchelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.forename: Lucio
authors.initials: L
authors.lastname: Giustini
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I - 60126 Torrette, Ancona, Italy. r.montironi@univpm.it.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
mesh_terms: D000369:Aged, 80 and over; D001706:Biopsy; D005834:Genital Neoplasms, Male / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D013085:Spermatic Cord / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography