Rapidly Progressive Dedifferentiated Liposarcoma of the Spermatic Cord: A Case Report

Dedifferentiated liposarcoma (DDLPS) of the spermatic cord is an exceptionally rare and aggressive malignancy for which diagnostic and therapeutic guidelines remain limited. We report the case of a 73-year-old man who presented with a rapidly enlarging left inguinal/paratesticular mass. Initial ultrasonography showed a 4.3 × 3.0 × 3.7 cm hypoechoic lesion interpreted as suggestive of leiomyoma. Pelvic magnetic resonance imaging subsequently demonstrated a 10 × 5 × 5 cm neoplastic mass arising from the spermatic cord. The patient underwent radical left orchiectomy. Histopathological examination revealed a high-grade spindle-cell neoplasm with marked pleomorphism and up to 30 mitoses per 10 high-power fields. Immunohistochemistry showed positivity for p16, MDM2, and CDK4, with a Ki-67 proliferative index of 95%, supporting the diagnosis of high-grade DDLPS. Although surgical margins were negative, the disease progressed rapidly. Nineteen days after surgery, the patient developed bilateral pleural effusion, pleural infiltration, pulmonary metastases, and a probable pathological T11 fracture. Because of extensive metastatic disease and clinical deterioration, systemic antineoplastic therapy was not initiated in this advanced setting. The patient died 27 days after hospitalization due to progressive metastatic disease. This case highlights the diagnostic difficulty, aggressive biological behavior, and need for early multidisciplinary management of spermatic cord DDLPS.