High grade dedifferentiated liposarcoma of the spermatic cord: an uncommon inguinoscrotal malignancy in an elderly male

Background: Paratesticular sarcomas are rare, with liposarcoma the commonest histology; dedifferentiated variants are exceptionally uncommon and aggressive. Case presentation: A 75 year old man presented with fever and lower urinary tract symptoms. During evaluation, an incidental large right inguinoscrotal mass was identified. Imaging (ultrasonography, contrast enhanced CT, and FDG PET CT) revealed a heterogeneous, necrotic mass arising from the right spermatic cord without nodal or distant metastasis. He underwent composite wide local excision of the spermatic cord tumour with radical orchidectomy. Histopathology showed a high grade spindle cell neoplasm with pleomorphism and tumour giant cells, admixed with adipocytes; immunohistochemistry demonstrated diffuse p16 and strong MDM2 positivity with patchy SMA and scattered SOX10, while AE1/AE3, desmin, caldesmon, S100, ALK1, CD117, calretinin, myogenin and MyoD1 were negative, consistent with dedifferentiated liposarcoma (FNCLCC grade 3). All margins were negative. Postoperative recovery was uneventful, and the patient remains under surveillance. Conclusions: Dedifferentiated liposarcoma of the spermatic cord should be considered in elderly men presenting with heterogeneous inguinoscrotal masses. Complete surgical excision with negative margins and long term follow up are essential due to a high risk of local recurrence.