Ricardo J. Fraticelli-Rosado, MD, Maria R. Cochran-Perez, MD, Gilberto Ruiz-Deya, MD, Limael Rodriguez Vega, MD
Department of Surgery, Hospital Episcopal San Lucas, Ponce, Puerto Rico, USA (Drs Fraticelli-Rosado, Ruiz-Deya, and Rodriguez Vega). Transitional Residency Program, Hospital Damas, Ponce, Puerto Rico, USA (Dr. Cochran-Perez). Ponce Health Sciences University, Ponce, Puerto Rico, USA (Dr. Ruiz-Deya).
Introduction: Scrotal liposarcoma is a very rare scrotal malignancy that is a diagnostic and therapeutic challenge for the treating surgeon.
Case Description: A 47-year-old man presented with a recent onset of bilateral testicular swelling and increasing discomfort. The patient had undergone an uneventful laparoscopic bilateral inguinal hernia repair 6 months prior and had been symptom free at 1 month after surgery. Now, the patient had developed recurrent swelling of his right scrotal area and nocturia. A computed tomographic scan revealed a lipomatous mass extending into the inguinal canal, and a decision was made to explore and resect the mass via a laparoscopic approach. Exploration revealed a large fatty mass extending from the inguinal canal to the retropubic space. After careful dissection of the mass off the inguinal vessels, it was pushed into the inguinal canal for later removal through the scrotum. The inguinal defect was covered with an absorbable mesh via laparoscope, and the dissection and transscrotal removal of the fatty mass was completed. Pathology revealed scrotal liposarcoma. At the 4-month follow-up, the patient was asymptomatic and a computed tomographic scan revealed no masses or signs of recurrence. At the 1-year follow-up, the patient remained disease free.
Conclusion: This case demonstrates an uncommon scrotal malignancy. Open surgery with orchiectomy is the surgical technique that most surgeons use. We have demonstrated that a laparoscopic approach is a viable alternative that can provide negative margins and testicular preservation.
Key Words: Laparoscopy, Orchiectomy, Scrotal liposarcoma, Scrotal mass.