A 66-year-old patient presented with a slow and progressive paratesticular tumor of approximately 6 months duration, with no other symptoms.
The physical examination showed a left intraosseous mass of approximately 10 cm in diameter, not painful, with a hard consistency, with a negative transfixation degree I, with no regional adenopathies; the rectal examination showed the presence of a nodule
Seizures: PSA 1276 ng/ml, alkaline phosphatase, Bgonadotropin and alpha-fetoprotein normal.
Ultrasound shows a homogeneous hypoechoic mass with areas of lower echogenicity and images of low vascularization inside, of 9 x 8.5 x 12 cm without being able to establish the structures of the left admissible prostate.
Scintigraphy showed the presence of bony metastases in the right sacral region, spinal cord, cranial nerve, and left shoulder.
Prostatic transrectal biopsy is not performed by patient's decision.
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The patient underwent surgery with radical orchiectomy.
Treatment was initiated with complete hormonal blockade and external radiotherapy was administered to treat right bone lesions without complications.
The anatomopathological study describes a mass of 12 cm in diameter, tumor aspect, whitish-colored extended cells with scarce hyarillent stroma, more intense yellowish color; the microscopic study shows a well defined neoplasia.
Immunohistochemistry shows positivity for vimentin and to a lesser extent CD34 and negativity for PSA, desmin, S-100, actin HHF35, sclerodifferentiating actin and myogenin D being diagnosed sclerosarcoma.
After a 12-month follow-up there is no evidence and PSA is 0.2 ng/ml and alkaline phosphatases 125 U.
