Specific Surgical Topics: A Multidisciplinary Management of Paratesticular Sarcomas in Adults

Abstract

Primary paratesticular sarcomas are rare, affecting primarily older men between the ages of 50 and 80 years. They are the most common tumors of the paratesticular region and usually present insidiously as an asymptomatic slow-growing mass. Because of the rarity of these tumors, there is no common consensus regarding the best management, especially in the adjuvant setting. In adults, 75–80% arise from the spermatic cord and the remainder from the epididymis, tunic, or testicular appendages. Among the malignant tumors, the most common histotype is liposarcoma (46.4%), followed by leiomyosarcoma (20%), malignant fibrous histiocytomas (13%), and embryonal rhabdomyosarcoma (9%). Of these, rhabdomyosarcoma, rare after the age of 40, is the most common malignant mesenchymal tumor in children and is considered the most aggressive sarcoma. It has an increased ability to spread via the lymphatic or hematogenous route. The main dissemination pattern of adult paratesticular sarcomas is by local invasion through the contiguous inguinal canal and less commonly via hematogenous or lymphatic channels. Surgery represents the first and the most effective therapeutic approach to most paratesticular sarcomas, and overall, the prognosis after diagnosis has been related to grading, size, depth of invasion, and surgical margin status.