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Il Giornale di Chirurgia

Retroperitoneal well-differentiated liposarcoma presenting as an incarcerated inguinal hernia

Casistica clinica, 315 - 317
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English version
A 69-year-old man was admitted with a complaint of left irreducible inguinal mass. On surgical exploration no evidence of hernia was found and the inguinal floor was overwhelmed by a large lobulated mass, arising from the properitoneal fat, that involved the spermatic cord. The mass was partially removed, sparing the elements of cord. The transversalis fascia was repaired by direct suture and a polypropylene mesh was located above. The histopathological diagnosis was well differentiated-type liposarcoma with myxoid features.
The liposarcoma is a malignant tumour of the adipose tissue that arises from the primitive mesenchymal cells. These neoplasms have been usually found in the soft tissues of limbs, trunk, mediastinum, retroperitoneum and occasionally in the spermatic cord. The clinical aspect is frequently a complaint of scrotal or inguinal painless mass, mimicking to an inguinal hernia and the diagnosis of tumor is performed mainly during surgery, as in our patient.
In the case of a firm not reducible painless inguinal mass without signs and symptoms of bowel obstruction, an abdominal tumor with inguinal or scrotal extension should be suspected and preoperatively excluded. The US and CT scan may be helpful to plane a correct therapeutic strategy before intervention.

Versione italiana
Un uomo di 69 anni veniva ricoverato con diagnosi di ernia inguinale sinistra non riducibile.
All'esplorazione chirurgica non veniva evidenziato un sacco erniario, ma il pavimanto del canale inguinale era sovvertito per la presenza di una massa polilobulata che emergeva dal grasso retroperitoneale e coinvolgeva il cordone spermatico. La massa veniva asportata parzialmente, risparmiando gli elementi del funicolo. La fascia transversalis veniva riparata con sutura diretta e sopra di essa veniva posizionata una mesh piana in polipropilene. L'esame istologico deponeva per un liposarcoma ben differenziato, con aspetti mixoidi.
Il liposarcoma è un tumore maligno del tessuto adiposo che origina delle cellule mesenchimali primitive. Questi tumori si localizzano generalmente nei tessuti molli degli arti, del tronco, del mediastino, del retroperitoneo e occasionalmente a livello del funicolo spermatico. In quest'ultimo caso il tumore si presenta come una massa, generalmente non dolente, che simula un'ernia inguinale. La diagnosi di neoplastia è di solito intraoperatoria, come nel nostro paziente.
Riteniamo pertanto che, in presenza di massa inguinale dura, non dolente, non riducibile, senza segni e sintomi di occlusione intestinale, vada comunque sospettato o escluso in fase preoperatoria che possa trattarsi di un tumore addominale con estensione inguinale o inguinoscrotale. L'ecografia e la tomografia computerizzata sono d'ausilio nel pianificare una corretta strategia terapeutica preoperatoria.

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