Paratesticular leiomyosarcoma treated by enucleation.

Spermatic cord leiomyosarcomas are rare tumors and standard treatment consists of radical orchiectomy and high cord ligation. We report a case of a paratesticular leiomyosarcoma successfully treated by enucleation. A 22-year-old man presented with a 6-months history of inguinal pain. Physical examination revealed a right paratesticular nodule about 0.5 cm in diameter. Inguinal exploration and nodule biopsy were performed. It was thought to be a benign epididymal nodule on a quick section and the tumor was enucleated and sent for paraffin section. Histology and immunohistochemistry were compatible with leiomyosarcoma. The patient was advised to undergo radical orchiectomy with high cord ligation. However, he refused surgery. An alternative approach with clinical, biochemical and radiological follow-up was adopted. The patient has been followed up for thirteen years and shows no evidence of disease.