Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery

Stuart Enoch¹^,2 , Simon M Wharton¹ and Douglas S Murray¹

¹West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK

²Wound Healing Research Unit, University Department of Surgery, University of Cardiff/University Hospital of Wales, Cardiff, – CF14 4UJ, UK

author email corresponding author email

World Journal of Surgical Oncology 2005, 3:23doi:10.1186/1477-7819-3-23


Published:	28 April 2005

Abstract

Background

Leiomyosarcomas (LMS) of the spermatic cord are extremely rare. Radical inguinal orchiectomy and high ligation of the cord is the standard primary surgical procedure. The extent of surrounding soft tissue excision required and the precise role of adjuvant radiotherapy, however, remains unclear. In addition, recurrence is a commonly encountered problem which might necessitate further radical excision of adjacent soft tissues.

Methods

This article reviews the pathophysiology of spermatic cord leiomyosarcomas (LMS), and discusses the various reconstructive surgical options available to repair the inguinal region and the lower anterior abdominal wall after excision of the tumour and the adjacent soft tissues.

Results

There is paucity of literature on LMS of spermatic cord. The majority of paratesticular neoplasms are of mesenchymal origin and up to 30% of these are malignant. In adults, approximately 10% of spermatic cord sarcomas are LMS. Approximately 50% of these tumours recur loco-regionally following definitive surgery; however, the incidence decreases if resection is followed by adjuvant radiotherapy.

Conclusion

It is therefore important to achieve negative histological margins during the primary surgical procedure, even if adjuvant radiotherapy is instituted. If extensive resection is required, either during the primary procedure or following recurrence, reconstructive surgery may become necessary. This article reviews the pathophysiology of spermatic cord LMS, the reasons for recurrence, and discusses the management options including the role of reconstructive surgery.