Indian Journal of Pathology and Microbiology

: 2009  |  Volume : 52  |  Issue : 1  |  Page : 91--93

Primary high-grade testicular leiomyosarcoma

Mohan Kumar1, Shashikant C.U Patne1, Sandip Kumar1, VK Shukla2,  
1 Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh, India
2 Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh, India

Correspondence Address:
Mohan Kumar
Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh


We herein present an extremely rare occurrence of primary intratesticular leiomyosarcoma. A 65-year-old patient presented with painless enlargement of the right testis. A high inguinal orchiectomy was done. Histopathological examination of the excised mass was consistent with high-grade leiomyosarcoma. Pertinent literature is reviewed and the importance of excluding the germ cell tumor and the paratesticular neoplasm is emphasized.

How to cite this article:
Kumar M, Patne SC, Kumar S, Shukla V K. Primary high-grade testicular leiomyosarcoma.Indian J Pathol Microbiol 2009;52:91-93

How to cite this URL:
Kumar M, Patne SC, Kumar S, Shukla V K. Primary high-grade testicular leiomyosarcoma. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 Jan 25 ];52:91-93
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Full Text


Leiomyosarcoma of the testis is known to occur following radiotherapy, following the use of anabolic corticosteroids and in association with testicular germ cell tumors. However, occurrence of testicular leiomyosarcoma without these events (primary intratesticular leiomyosarcoma) is extremely rare. To our knowledge, only nine cases of primary intratesticular leiomyosarcoma have been reported. [1],[2],[3],[4],[5],[6],[7],[8] These cases are reviewed and compared in [Table 1]. We herein present one such rare occurrence of a primary intratesticular leiomyosarcoma in an elderly person.

 Case Report

A 65-year-old male presented with discomfort and painless enlargement of the right testis over the past 2 months. No urologic or constitutional symptoms were present. He did not receive any radiation therapy or anabolic corticosteroids in the past. A local examination revealed a hard mass of 13x8x6 cm in the right testis without associated inguinal adenopathy. An ultrasonography of the right scrotum showed an intratesticular complex mass 8.5x6.6 cm in size. Hypoechoic solid and cystic areas were evident in the mass with marginal calcification. The contralateral testis and the spermatic cord were unremarkable. A systemic examination; computed tomography (CT) scans of the chest, abdomen and pelvis; and routine hematologic profiles were all within the normal limits. His serum level of a feto protein (AFP) was 2.3 ng/ml (normal [9] Leiomyosarcoma of the scrotum have been classified into the paratesticular and the intratesticular, the latter being an uncommon neoplasm with the rare potential for distant metastasis. [3] Intratesticular leiomyosarcoma is believed to arise from the smooth muscle elements of the testicular parenchyma such as the blood vessels or the contractile cells of the seminiferous tubules. [1],[6] Because of the extreme rarity, diagnosis of intratesticular leiomyosarcoma should only be given after a thorough gross and microscopic examination. Grossly, the more commonly seen paratesticular smooth muscle tumors originating from the spermatic cord and the epididymis should be ruled out. [5],[6] Moreover, co-occurrence of the sarcoma and the germ cell tumor is reported to have an adverse prognosis. [2] Therefore, before establishing the diagnosis of primary or pure intratesticular sarcoma, the presence of the germ cell tumor elements also needs to be excluded.

Patients with intratesticular leiomyosarcoma are usually older than 40 years. The majority of these patients present with painless testicular enlargement and inguinoscrotal discomfort. Owing to only a few reports, histological criteria for the diagnosis of intratesticular leiomyosarcoma are lacking in literature. In the presence of significant nuclear atypia, a mitotic count ≥10/10 high-power field and coagulative necrosis with nuclear debris are criteria for the diagnosis of uterine spindle cell leiomyosarcoma.[10] The same diagnostic criteria may well be used for the diagnosis of intratesticular leiomyosarcoma. As compared with leiomyosarcoma at the other sites, the prognosis of intratesticular leiomyosarcoma remains good. Out of the nine primary cases, only a single case of death due to pulmonary metastatic disease has been reported. [3] Radical orchiectomy (RO)/high inguinal orchiectomy (HIO) followed by surveillance appears to be the treatment of choice. [5],[6] Recently, a postradiotherapy high-grade leiomyosarcoma of the testis was managed by RO and follow-up. [9]

Eight of the previously nine primary intratesticular leiomyosarcoma were of either low grades or unspecified [Table 1]. Our patient has high-grade intratesticular leiomyosarcoma. Despite the high-grade tumor, our patient did not develop metastatic or recurrent disease. This indicates that irrespective of the tumor grade, a high inguinal orchiectomy is adequate treatment for these patients. It also offers further evidence that leiomyosarcoma in this location responds better than at any other site. However, a close follow-up is required, as death due to pulmonary metastasis has been reported 14 months after the orchiectomy in a 70-year-old patient. [3]


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