Giant malignant mesenchymoma of the spermatic cord with bidirectional differentiation

Background: Spermatic cord neoplasms are a rare tumor entity and, moreover, of benign behavior. Malignant tumors of the spermatic cord are mostly of m esenchymal origin. We present the unusual case of a giant malignant mesench ymoma of the spermatic cord with bidirectional differentiation into a lipos arcoma and a leiomyosarcoma. Case Report: A 84-year-old male patient presen ted with a scrotal mass on the left side which was observed growing since 1 year and misdiagnosed as scrotal hernia or testicular hydrocele. Ultrasoun d and computed tomography demonstrated a solid tumor suggesting a spermatic cord tumor. The patient underwent hemiscrotectomy, and the histological ex amination of the 2,500-gram specimen revealed a malignant mesenchymoma orig inating from the spermatic cord with two distinct histopathological compart ments of liposarcoma and leiomyosarcoma. Because an adjuvant therapy protoc ol is of questionable effect and because of the patient's age no further th erapy was applied. The patient was closely followed and is now, 5 years aft er surgery, still free of disease. Conclusion: Even in older patients, scro tal masses should be considered malignant tumors as long as no benign diagn osis has been proven. Although malignant mesenchymomas are rare tumors with poor prognosis, in selected cases even large tumor masses, as presented, c an be cured by surgery.