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CASE REPORT: SCROTUM LEIOMYOSARCOMA

Introdução, Material, Método, Resultados, Discussão e Conclusões

INTRODUCTION:The testicular leiomyosarcoma a rare condition, whose differential diagnosis is performed through criteria of mitotic activity, size and cellularity. Treatment is the radical orchidectomy since chemotherapy and radiotherapy have no significant impact on morbidity and mortality. CASE REPORT: A 52 years old man presented with a right testicle lump for twenty five years post-trauma. For ten months, the nodule changed his consistency, it became fixed and painful. After five months of the first care, the patient performed a right orchiectomy. Testiculal ultrasound (right testicle): enlarged, heterogeneous volume epididymis with calcifications, with solid nodules (4,2 x 3,8 cm), with satellite adenomegalyin the inguinal region. Anatomopathological right testicle features fusocellular mesenchymal neoplasm, minor lesion: 3 mitoses per 10 high-power fields (HPF) and major lesion: 6 mitoses per 10 HPF. An area of necrosis present in 10% corresponds to leiomyosarcoma. Immunoh istochemistry: High grade sarcoma (Leiomyosarcoma grade 3). Chest tomography: Presence of nodular image with soft tissue density in the left lung, T2N0M1. Conduct: First line chemotherapy: Docetaxel associated with Gemcitabine. DISCUSSION: Malignant tumors of testicle and paratesticular are rare. Usually there are sarcomas in the scrotum, such as: Rhabdomyosarcoma, malignant fibrous histiocytomas, liposarcoma and leiomyosarcoma. As regards Leiomyosarcoma, it is noted that it originates in the tunica dartos. Although the criteria are not consensual, the existence of five or more mitoses per 10HPFis considered as an indicator of malignity. However, mitotic activity is the most relevant factor as regards metastasis. Other criteria include the size, cellular atypia and lesion’s necrosis. Metastasis occurs through hematogenous dissemination and, when it is through lymphatic, the usual ganglionic chain is the iliac and inguinal. The treatment is radical orchiectomy. Chemotherapy and radio therapy are not recommended as adjunctive therapy, as they don’t have an impact on morbidity and mortality. The incidence of metastasis is limited to the rarity of this cancer. CONCLUSION: Testicular Leiomyosarcoma is a rare tumor. The criteria of mitotic activity are the most used for differential diagnosis and better treatment is the surgery.

Palavras Chave

Leiomyosarcoma; radical orchiectomy; testicular leiomyosarcoma