Spermatocytic tumor coexisting with a contralateral inguinoscrotal undifferentiated sarcoma: a case report

Spermatocytic tumors represent uncommon neoplasms of the testes and are mostly indolent with favorable prognosis in the non-metastatic stage. Rarely, they can undergo sarcomatous transformation, significantly worsening prognosis. This case highlights a patient harboring a testicular spermatocytic tumor and a concomitant sarcoma of the contralateral inguinoscrotal soft tissue, not related to the spermatocytic tumor.

A 77-year-old male patient presented with a left scrotal mass and a suspected right inguinoscrotal hernia. Laboratory values showed a slightly elevated alpha-1-fetoprotein, while beta-human chorionic gonadotropin and lactate dehydrogenase were within normal limits. Ultrasound imaging revealed a diffusely enlarged, inhomogeneous left testis, highly suspicious for testicular malignancy. Staging revealed no lymphatic or distant metastases. The patient underwent left radical orchiectomy. Histological analysis revealed a spermatocytic tumor of the left testis. Intraoperatively, a gelatinous mass in the contralateral right inguinoscrotal area was discovered and biopsied. The mass on the right was identified as a sarcomatous tumor. Subsequent management entailed radiotherapy, followed by radical resection and scrotectomy with preperitoneal mesh reinforcement. Pathologic workup including molecular genetic testing showed different immunohistochemical and molecular profiles in both tumors. This led to the final diagnosis of a coexisting undifferentiated sarcoma.

Despite being uncommon and generally less aggressive compared to other testicular malignancies, spermatocytic tumors necessitate vigilance for potential sarcomatous transformation. In this case, a sarcomatous transformation of a spermatocytic tumor was excluded and diagnostics instead revealed an even rarer case of a coexisting undifferentiated sarcoma of the contralateral inguinoscrotal soft tissue. To our knowledge, this is the first reported case of a spermatocytic tumor with a coexisting, unrelated sarcoma. The rarity of these entities underlines the importance of multidisciplinary team meetings for accurate diagnosis and optimal treatment-related decisions.