Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature

Our plain-English summary of Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature, by P.H. Blitzer, D.E. Dosoretz, K.H. Proppe, et al (The Journal of Urology, 1981).

The study

• Authors: P.H. Blitzer, D.E. Dosoretz, K.H. Proppe, W.U. Shipley
• Journal: The Journal of Urology
• Published: 1981;126(5):611-4
• Cited by: 97 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Ten patients with sarcoma of the spermatic cord were treated at our hospital between 1940 and 1977. Although there are 191 reported cases in the literature controversy remains concerning optimal treatment. In our series of 10 patients 5 of 7 (71 per cent) followed for more than 5 years postoperatively have suffered local recurrence. Thus, we believe that this treatment is inadequate and recommend postoperative radiation therapy to the scrotum and pelvis. Of our patients 2 suffered recurrence in the retroperitoneal lymphatics and we favor dissection of these nodes as part of the initial treatment.

In plain English

This article described 10 patients treated at Massachusetts General Hospital in Boston from 1940 through 1977 for malignant tumors of the spermatic cord, and reviewed 191 published cases. The article does not mention asbestos or any tumor cause. Five patients had leiomyosarcoma, 2 liposarcoma, 1 rhabdomyosarcoma, 1 malignant mesothelioma and 1 an unclassified tumor. The mesothelioma patient, aged 74, had no evidence of disease 30 months after radical orchiectomy. Local recurrence, the most frequent problem, occurred in 5 patients, 2 of whom died. Two patients developed spread through the bloodstream, and both died. Of the 7 patients followed at least 5 years, 71 per cent had local regional failure. Only one patient had radiation right after surgery; follow-up was too short for conclusions. The authors concluded that orchiectomy with high ligation of the spermatic cord was, by itself, inadequate except for small (under 1 cm) and low grade lesions. As treatment policy, they recommended postoperative radiation to the scrotum and pelvis, favored para-aortic node dissection, and for medium and high grade sarcomas proposed dissection or radiation of pelvic and same-side groin nodes.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series from one hospital, combined with a review of previously published cases
• Who was studied: 10 patients with malignant tumors of the spermatic cord treated at Massachusetts General Hospital, Boston, from 1940 through 1977 (mean age 53.2 years, range 14 to 74). The authors also tabulated 191 cases previously reported in the literature.
• Exposure: No exposure was studied, and the article does not mention asbestos or any other cause. The article examined treatments (radical orchiectomy, local excision, radiation therapy, chemotherapy, lymph node dissection) and their outcomes.
• Main results:
  • Tumor types among the 10 patients were leiomyosarcoma in 5, liposarcoma in 2, rhabdomyosarcoma in 1, malignant mesothelioma in 1, and unclassified in 1.
  • The mesothelioma patient (case 9, age 74) had a painless 1 cm mass, grade II. That patient was treated by radical orchiectomy and had no evidence of disease at 30 months of follow-up.
  • Local recurrence occurred in 5 of the 10 patients, and 2 of those patients died.
  • Spread through the bloodstream (hematogenous metastasis) occurred in 2 patients, and both died.
  • Among the 7 patients followed for at least 5 years, the local regional failure rate was 71 per cent.
  • Of the 10 patients, 4 were alive without recurrent disease, but 3 of these 4 had been followed for less than 5 years.
  • Two patients (cases 2 and 3) whose regional lymph nodes were not treated at first later developed retroperitoneal lymph node involvement.
• The authors' conclusion: The authors concluded that orchiectomy with high ligation of the spermatic cord was, by itself, inadequate treatment except for small (less than 1 cm) and low grade lesions. As their current treatment policy, they treat the hemiscrotum and the entire true pelvis with radiation after surgery, and they favor surgical dissection of the para-aortic lymph nodes. For medium and high grade sarcomas, they believed that either surgical dissection or carefully planned irradiation should be used for the pelvic and ipsilateral inguinal (same-side groin) lymph nodes.
• Limitations the authors state:
  • Only one patient received radiation right after surgery, and follow-up of that patient was too short to draw conclusions.
  • The previously published reports lacked patient numbers, treatment details or long follow-up, which limited their usefulness for judging treatment.

Topics

Medical terms in this study, explained in our Lexicon: Spermatic Cord, Sarcoma.

Related studies

• Carcinosarcoma of the spermatic cord — M. Nistal, F. Burgos, et al. (1990)
• Tumors of the spermatic cord: a review of the literature and a report of a case of lymphangioma — A.A. el-Badawi, M.M. al-Ghorab (1965)
• Mesothelioma of spermatic cord: electron microscopic and histochemical characteristics of its mucopolysaccharides — P. Pizzolato, J. Lamberty (1976)
• Malignant Mesothelioma of Spermatic Cord in an Elderly Man With a History of Asbestos Exposure — A. D'Antonio, F. Mastella, et al. (2016)
• Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India — P.A.M. Paul, N. Calton, et al. (2021)
• Malignant mesotheliomas in spermatic cords: reports of two cases and a brief review of literature — X. Meng, T.J. Guzzo, et al. (2013)

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