A 61-year-old patient with a left adrenal tumor of 7 years of evolution has caused nonspecific local discomfort.
Echocardiography diagnosed an enlarged left pouch, probably due to herniation of epiptysis, hydrocele and left varicocele.
Five years later a 5 cm tumor appears in the intracranial area.
Clinical summary: the clinical characteristics of the three cases are shown in Table I. The age of presentation is between 36 and 67 years.
All occur in the cord is persistent.
One case is right and two left.
Recurrence occurs in the inguinal region on the same side.
The predominant symptom is palpable intraosseous mass.
In the case of recurrence (3B) it debuts at five years as an inguinal mass in the area of previous surgery.
Ultrasound revealed heterogeneous solid extratesticular masses.
Computed tomography demonstrated the presence of solid extratesticular and intraepithelial masses with fat component, in case 2, of areas with soft tissue density.
Macroscopically, the tumors have a lobulated surface, consisting of nodules with a tapered texture and other nodules with a soft consistency and a white or gray coloration.
The neoplasms measured between 10 and 21 cms (mean 16 cms), and the case of recurrence measured 5 cms of major axis.
1.
Histologically, the three tumors show well differentiated areas of the 'lipoma-like' type, with the presence of adipocytes with variability in shape and size, variable nuclear atypia, and lipoblasts.
Case No. 1 shows among the well differentiated areas 'lipoma-like' the existence of a plasmatic patch and hyaline fibrous fibrous cells with fusiform cells that show variable nuclear atypia, forming sclerosing areas and inflammatory lymphocytes.
Myxoid stromal areas with cytology similar to sclerosing areas, histological grade I are also observed. This is a well differentiated liposarcoma with mixed pattern 'lipoma-like', sclerosing and inflammatory.
Case number 2 has areas of LPS 'lipoma-like' that change with areas of sclerosing type or in beetles, and 20% show areas of fibromorphic pattern and consistent mitotic foci with focal fibromorphism.
These dedifferentiated areas account for 20 % of the total extent of the neoplasm.
We conclude that it corresponds to a high grade dedifferentiated liposarcoma.
Case 3 is a well-differentiated low grade liposarcoma (Grade I) with extensive areas of 'lipoma-like neoplasia' type and only sclerosing differentiation in 20%.
Case 3 presented an inguinal local recurrence (3aB) five years after the diagnosis of the original tumor.
The tumor measured 5x3.5x3 cms and showed a low-grade dedifferentiated LPS morphology consisting predominantly of spindle cells over a myxoid stroma without plexiform vascular plexus.
The four cases show in common the absence of necrosis, cell proliferation index lower than or equal to 5% and absence of protein expression p 53.
Currently all patients are free of disease.
