Radio-recurrent spermatic cord leiomyosarcoma requiring radical surgery and reconstruction using a myocutaneous (tensor fascia lata) flap: a case report and review of the literature

Leiomyosarcomas (LMS) of the spermatic cord are exceedingly rare tumours. Radical inguinal orchiectomy and high ligation of the cord is the standard primary procedure. The extent of soft tissue excision required, including margins, and the precise role of adjuvant radiotherapy (RT), however, remains unclear. A 58-year-old male underwent excision of a large inguinoscrotal mass and orchiectomy. Histological examination revealed the mass to be a LMS of the spermatic cord with the tumour extending to one of the resection margins. Further surgery was nevertheless withheld for fear of creating a significant anatomical defect and hence the patient was referred for radiation therapy. He developed locoregional recurrence 2.5 years later which necessitated radical excision of soft tissues in the lower–anterior abdominal wall and inguinal region, and reconstruction using a tensor fascia lata flap. This report emphasizes the need for primary radical surgery until negative histological margins are achieved even if it involves sacrificing some adjacent normal anatomy. If margins are positive after primary surgery, re-excision should be the rule rather than the exception. Adjuvant RT, though useful, should not be considered as a substitute for complete surgical clearance. To the authors knowledge, this is the first report in medical literature of a case of spermatic cord LMS recurring after surgery and RT, requiring further radical surgery. The pathophysiology and the management of this complex and rare tumour are also reviewed.