A Case Report of Well-Differentiated Liposarcoma Presenting as a Primary Inguinal Mass: Diagnostic Challenges and Management
Keywords:
Liposarcoma, Well-Differentiated Liposarcoma, Inguinal Tumor, Spermatic Cord, Soft Tissue SarcomaAbstract
Introduction: Liposarcoma (LPS) is the most common soft tissue sarcoma in adults, yet its presentation as a primary mass in the inguinal region is exceedingly rare. This atypical location poses a significant diagnostic challenge, as the clinical signs often mimic more common benign conditions such as inguinal hernia or lipoma, which can lead to delayed diagnosis or inadequate initial management. This report details a case of well-differentiated liposarcoma (WDLS) in the inguinal canal, highlighting the clinical, radiological, and pathological nuances critical for accurate diagnosis and definitive treatment.
Case Illustration: A 49-year-old male presented with a one-month history of a right inguinal lump that had rapidly enlarged over the preceding week, accompanied by intermittent pain. Physical examination revealed a mobile, tender mass measuring approximately 2x3 cm. Ultrasound imaging was pivotal, identifying a solid, heterogeneous, vascularized lesion, which raised the suspicion of a neoplasm beyond a simple lipoma. The patient subsequently underwent a wide excisional biopsy.Histopathological examination revealed a tumor composed of mature adipocytes with scattered atypical, hyperchromatic stromal cells and neoplastic lipoblasts, confirming the diagnosis of well-differentiated liposarcoma. A notable and potentially misleading feature was the presence of a prominent "chicken wire" vascular pattern within the stroma, a finding more classically associated with myxoid liposarcoma.1
Discussion: This case underscores the importance of maintaining a high index of suspicion for malignancy in patients presenting with atypical inguinal masses. Preoperative imaging, particularly ultrasound with Doppler, is invaluable for identifying features suggestive of sarcoma, thereby guiding appropriate surgical planning toward a wide excision rather than a simple enucleation. The finding of a "chicken wire" vascular pattern within a WDLS represents a significant diagnostic pitfall, emphasizing the need for comprehensive morphological assessment and, in equivocal cases, ancillary molecular testing to avoid misclassification and subsequent inappropriate adjuvant therapy. Wide surgical excision with negative margins remains the cornerstone of treatment for localized WDLS.
Conclusion: Well-differentiated liposarcoma is an essential, albeit rare, differential diagnosis for solid inguinal masses. Optimal patient outcomes are contingent on a multidisciplinary approach encompassing astute clinical suspicion, appropriate imaging, meticulous pathological evaluation, and definitive surgical management. Given the high risk of local recurrence and the potential for dedifferentiation into a more aggressive sarcoma, a structured protocol of long-term, lifelong surveillance is mandatory following initial treatment.
Keywords: Liposarcoma, Well-Differentiated Liposarcoma, Inguinal Tumor, Spermatic Cord, Soft Tissue Sarcoma.References
Aleixo, P.B., Hartmann, L.C., Rao, P., et al. (2009) 'CDK4 amplification is a common adverse prognostic factor in patients with dedifferentiated liposarcoma.' Clinical Cancer Research, 15(20), pp. 6531-6539.
Atlas of Genetics and Cytogenetics in Oncology and Haematology. (n.d.). Soft tissues: well differentiated liposarcoma. Available at: https://atlasgeneticsoncology.org/solid-tumor/5167/soft-tissues-well-differentiated-liposarcoma (Accessed: October 2023).
Binh, M.B., Sastre-Garau, X., Guillou, L., et al. (2010) 'MDM2 and CDK4 immunohistochemistry is a valuable tool in the differential diagnosis of low-grade osteosarcomas and other primary fibro-osseous lesions of the bone.' Modern Pathology, 23(5), pp. 624-637.
Bolodeoku, J., Robb, J., and Hopyan, S. (2016) 'Myxoid liposarcoma: A review of the literature.' Sarcoma, 2016, 5183859.
Cleveland Clinic. (2021). Liposarcoma. Available at: https://my.clevelandclinic.org/health/diseases/21142-liposarcoma (Accessed: October 2023).
Crago, A.M., and Brennan, M.F. (2016) 'Liposarcoma: A review of the etiology, diagnosis, and treatment.' Surgical Clinics of North America, 96(5), pp. 1033-1048.
Flucke, U., and van Noesel, M.M. (2017) 'Well-differentiated and dedifferentiated liposarcoma.' In: WHO Classification of Tumours of Soft Tissue and Bone. 5th ed. Lyon: IARC Press, pp. 35-38.
Gounder, M.M., Mahoney, K.M., and Van Tine, B.A. (2024) 'Liposarcoma: A Review of the Literature.' Cancers, 16(22), 3858.
Hajj, A., El-Hajj, M., El-Haddad, M., et al. (2017) 'Liposarcomas of the spermatic cord: A case report and review of the literature.' Biomedical Reports, 6(5), pp. 589-592.
Hammad, A., El-Ghoneimy, A., and El-Meligy, M. (2015) 'Spermatic cord liposarcoma: a case report and review of the literature.' Journal of Surgical Case Reports, 2015(7), rjv088.
Hansen, T.G., Kold, O., Guldberg, R., and Laurberg, J.M. (2017) 'De-differentiated liposarcoma in the spermatic cord: a case report.' Translational Andrology and Urology, 6(3), pp. 588-591.
Kilpatrick, S.E., Fritchie, K., and Goldblum, J.R. (2012) 'The morphologic spectrum of myxoid liposarcoma.' American Journal of Clinical Pathology, 137(2), pp. 229-239.
Kransdorf, M.J., Bancroft, L.W., Peterson, J.J., et al. (2009) 'Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma.' Radiology, 251(1), pp. 225-234.
Kubo, T., Sugita, T., Aoyama, T., et al. (2012) 'Surgical treatment for well-differentiated liposarcoma of the limbs.' Anticancer Research, 32(5), pp. 1821-1825.
Lahat, G., et al. (2008) 'Outcome of locally recurrent and metastatic sarcoma after contemporary multimodality treatment.' BMC Cancer, 8, 4. As cited in OncoDaily (n.d.). Liposarcoma.
Lee, S.M., Lee, H.J., Park, Y.K., et al. (2019) 'Atypical lipomatous tumor/well-differentiated liposarcoma with myxoid stroma: a clinicopathologic study of 10 cases with molecular analysis.' Human Pathology, 89, pp. 10-18.
Leibovitch, I., Czerniak, A., Ramon, J., et al. (1995) 'Liposarcoma of the spermatic cord: report of 6 cases and review of the literature.' The Journal of Urology, 153(1), pp. 154-157.
National Cancer Institute. (2024). Adult Soft Tissue Sarcoma Treatment (PDQ®)–Health Professional Version. Available at: https://www.cancer.gov/types/soft-tissue-sarcoma/hp/adult-soft-tissue-treatment-pdq (Accessed: October 2023).
OncoDaily. (n.d.). Liposarcoma. Available at: https://oncodaily.com/oncolibrary/cancer-types/liposarcoma (Accessed: October 2023).
OrthoBullets. (2023). Liposarcoma. Available at: https://www.orthobullets.com/pathology/8068/liposarcoma (Accessed: October 2023).
Radiopaedia.org. (n.d.). Atypical lipomatous tumour / well-differentiated liposarcoma (ALT/WDLPS). Available at: https://radiopaedia.org/articles/atypical-lipomatous-tumour-well-differentiated-liposarcoma-altwdlps (Accessed: October 2023).
Sarcoma Oncology Center. (n.d.). Well-Differentiated Liposarcoma. Available at: https://sarcomaoncology.com/types-of-sarcoma/soft-tissue-sarcomas/liposarcoma/well-differentiated-liposarcoma/ (Accessed: October 2023).
Sarcoma UK. (n.d.). Liposarcoma. Available at: https://sarcoma.org.uk/about-sarcoma/what-is-sarcoma/types-of-sarcoma/liposarcoma/ (Accessed: October 2023).
Schwartz, S.L., Swierzewski, S.J., and Sondak, V.K. (2010) 'Liposarcoma of the spermatic cord: a case report and review of management.' UroToday International Journal, 3(4), art 45.
Sirbaboma, P., and Gopinath, A. (2022) 'A rare case of well-differentiated liposarcoma with CDK4 amplification but without MDM2 amplification.' Research Square, [Preprint].
Wang, M., Fu, Y., Liu, X., and Liu, Z. (2025) 'Case Report: a giant liposarcoma of the spermatic cord.' Frontiers in Oncology, 15, 1490559.
Wang, Y., Li, Y., Wang, J., et al. (2024) 'Liposarcoma: a review of current management.' Frontiers in Oncology, 14, 12104207.
WebPathology. (2021). Well-Differentiated and Dedifferentiated Liposarcoma. Available at: https://www.webpathology.com/images/soft-tissue/lipomatous/liposarcoma-well-diff-and-de-diff/44181 (Accessed: October 2023).
Wikipedia. (2024). Liposarcoma. Available at: https://en.wikipedia.org/wiki/Liposarcoma (Accessed: October 2023).
Yang, L., Chen, S., Luo, P., et al. (2020) 'Liposarcoma: Advances in cellular and molecular genetics alterations and corresponding clinical treatment.' Journal of Cancer, 11(1), pp. 100–107.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Komang Budhi Pradnya Wibawa, Gede Bayu Wedanta Netra (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
