Less than 200 cases of para-testicular liposarcoma (PTL) have been reported. PTL may present with painless or painful intra-scrotal or inguinoscrotal mass of long duration or recent onset but the most common presentation is a painless mass. Para-testicular liposarcomas does mimic various common intra-scrotal and inguinoscrotal masses, some of which include: inguinal hernia, lipoma, fibroma, fibrosarcoma, leiomyoma, leiomyosarcoma, rhabdomyosarcoma, various types of testicular tumours and other non-common intra-scrotal lesions. The symptoms tend to be non-specific. PTLs tend to be unilateral but bilateral cases have been reported. Radiology imaging would define the features of the lesion. Fine needle aspiration cytology could establish the diagnosis but the diagnosis tends to be established by pathology examination of the excised specimen of the tumour which would show spindled-tumoral cells with atypical features and mitotic activity and lipoblasts. Immunohistochemistry staining studies of the tumour would exhibit positive staining for MDM2, CDK4, S100 and STAT6. PTL is treated by trans-inguinal radical orchidectomy ensuring complete excision of the tumour with tumour-free excision margin plus adjuvant radiotherapy plus / minus adjuvant chemotherapy for localized disease. For metastatic and advanced lesions, radical trans-inguinal orchidectomy plus radiotherapy plus chemotherapy should be undertaken. New chemotherapy options need to be developed to effectively destroy para-testicular liposarcoma tumour cells. All excised innocuous looking intra-scrotal masses that should be submitted for histopathology examination in order not to misdiagnose PTL as benign lipoma. Generally the prognosis of localized PTL tends to be good following radical orchidectomy with complete excision of tumour.
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