A 68-year-old male patient with a personal history of TURP due to benign prostatic hyperplasia in another center, whose pathological study showed the presence of a Gleason 6 adenocarcinoma with PSA values within the range of normal radiotherapy intention.
She consulted due to pain in the right groin of more than 2 years of evolution, which increases with standing and decreases with decubitus.
She was diagnosed with a direct right inguinal hernia and an inguinal hernia repair and a concomitant right hydrocele were performed.
At the same time, a giant carnosal tumor adhered to the upper pole of the testicle of 2 cm in diameter larger is observed.
Right radical orchiectomy was performed via inguinal approach and cord excision was performed through an internal inguinal ring.
There was no evidence of lymphadenopathy.
The anatomopathological study showed an oosarcoma with positivity for the immunohistochemical study of Actin and Vimentin and negative for Ankylosing Prosecutive Laws and Pathogens.
1.
The extension study was normal.
Complementary radiotherapy is proposed.
At 9 months there is an excretory lesion of 3 x 2.5 cm in the scar of the herniorrhaphy that is resected, reporting recurrence of leiomyosarcoma with increased mitotic activity.
No adjuvant activity.
At 6 months, a new nodular lesion in the right flank with progressive increase in size was observed.
In the A.T.A.C., a nodule is evident which depths subcutaneous fat and iliopsoas muscle.
The tumor was resected together with fibers of the lesser oblique, transverse muscle and iliopsoas muscle.
Pathological report is compatible with leiomyosarcoma.
At this point adjuvant therapy is proposed with a six-cycle regimen of adriamycin and ifosfamide.
After 12 months, a new surgical intervention was performed, with local recurrence, which was stunned to the touch, crossing the arterial and venous vessels of the inguinal area.
The report concludes a recurrence of high grade leiomyosarcoma.
Magnetic resonance imaging shows an inguinal adenopathic mass with retroperitoneal lymph nodes that reject all possibility of radical treatment.
It was decided to administer second-line chemotherapy with docetaxel and gemcitabine scheme for six cycles.
After 8 months of disease-free interval, the appearance of a new mass in the inguinal region together with lung metastases in the control A.C.T. was confirmed, so palliative treatment with adriamycin was decided.
Prior to this new recurrence, the patient presents an episode of hematuria that by ultrasound demonstrates the existence of an excretory lesion in the right bladder wall of 3 cm and confirmed by cystoscopy.
The patient dismisses the possibility of R.T.U. for being on a chemotherapy regimen and subsequent deterioration of general status.
