paratesticular tumors are infrequent tumors that have a high incidence of malignancy ; they are either soft - tissue tumors or mesothelial neoplasms .
paratesticular liposarcomas include all liposarcomas arising in the structures around the testis , including the lower end of the cord .
it is felt to arise from the extra peritoneal fat that becomes continuous distally with the fatty tissue of the cord .
they commonly present as painless , slowly growing masses that are usually diagnosed as being a lipoma or inguinal hernia .
however , complete surgical resection offers the best chance of cure for these patients , and the established method for orchiectomy for testes / cord cancer is through an inguinal incision .
a 65-year - old male patient presented with scrotal swelling of 2-year duration in both right and left hemiscrotum , which was gradually progressive in size and non - reducible . on examination ,
swelling was soft in consistency , testis was palpable posteriorly , and could not get above the swelling .
intraoperative , a firm , well - defined tumor , about 20  14  5 cms on the left and 16  14  4 cms on the right side were found at the proximal spermatic cord [ figure 1 ] ; no hernia sac was noted at the inguinal canal . bilateral high inguinal orchiectomy was performed .
the gross appearance of the specimen revealed a large , soft , well - circumscribed , multilobulated , fat - containing mass adhering to the spermatic cord and testis .
the cut surface of the tumor [ figure 2 ] showed yellowish and myxoid areas , but without hemorrhage or necrosis .
histopathological examination [ figures 3 and 4 ] showed sheets and nests of mature adipocytes , scattered atypical cells with hyper chromatic nuclei , and multivacuolated lipoblasts in between on a fibrous and myxoid background .
he , however , refused further treatment because he did not have enough money to continue treatment .
informed consent has been taken from the patient regarding the publication of the case report .
gross specimen of the tumor mass measuring 20  14  5 cms on left and 16  14  4 cms on the right cut section of the specimen showing yellowish and myxoid areas microscopic examination of the mass revealed an encapsulated proliferation consisting of mature adipocytes accompanied by both spindle - shaped cells and multivacuolated lipoblasts microscopic photograph showing mature adipocytes , spindle - shaped cells with hyper chromatic nuclei within the stromal tissue and multivacuolated lipoblasts in between on a fibrous and myxoid background
dreyfuss and lubash reported the first documented liposarcoma of the spermatic cord in a 54-year - old male in 1940 .
liposarcomas are soft - tissue malignancies that are commonly found in the lower extremities and retroperitoneum .
they are classified in four histology subtypes ( well differentiated , myxoid , pleomorphic , and dedifferentiated ) .
paratesticular tumors have a high incidence of malignancy , which is estimated as 30% in the documented literature , mostly arising from the spermatic cord .
most patients present with painless , slowly growing inguinal or scrotal masses , which are usually diagnosed as inguinal hernias or lipoma before surgical intervention . the majority of spermatic cord sarcomas begin their development just below the external inguinal ring and therefore , grows as a scrotal mass rather than as an inguinal mass .
the homogenous fatty pattern of well - differentiated paratesticular liposarcomas being similar to lipomas or omentum in the hernia sac makes the differential diagnosis of a liposarcoma difficult through ultrasonograhic studies .
hence , even though ultrasonography is the most helpful and commonly used diagnostic tool for differentiating cystic and solid lesions , an abdominal ct scan may be helpful .
since they have the tendency for local recurrence after inadequate resection , complete resection , including high ligation of the spermatic cord , is indicated . an intralesional biopsy or surgery
the role of adjuvant radiotherapy or chemotherapy remains controversial and is only limited in cases of metastatic tumors or in cases following incomplete resection .
radiation therapy may be employed as an adjunct to surgical resection in an attempt to avoid local recurrence .
the prognosis of paratesticular liposarcomas depends on the histological cell type , among well- differentiated , dedifferentiated pleomorphic , and myxoid / round cell types .
the well - differentiated and myxoid / round cell types have a better prognosis , but they tend to have a high incidence of local recurrence .
liposarcomas are the most radiosensitive of all sarcomas and in some cases remission has been achieved with radiotherapy alone .
in conclusion , liposarcomas of the spermatic cord represent a rare type of tumors , which are often misdiagnosed preoperatively .
being a rare disease and varied type of presentation , paratesticular liposarcoma should be considered as a possibility during the differential diagnosis of fat containing inguino - scrotal mass .
 paratesticular liposarcomas are rare tumors and are often reported as isolated cases . patients usually present with a painless scrotal or inguinal mass , mimicking inguinal hernia . 
 they refer to liposarcomas arising from the spermatic cord , testicular tunics , and epididymis . 
 we report a case of bilateral scrotal swelling which was misdiagnosed as inguinal hernia . 
 intraoperative diagnosis of testicular tumor was made . 
 high inguinal orchiectomy was done . 
 histopathological examination revealed it to be liposarcoma of the cord . to our knowledge 
 , there is no reported case of bilateral paratesticular liposarcoma in english literature , hence we report this case . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION