635 Giant Paratesticular Liposarcoma Imitating a Recurrent Right Inguinoscrotal Hernia

Case

48-year-old male presented for elective open recurrent right inguinal hernia (RIH) repair due to ongoing right inguinoscrotal swelling; and an ultrasound suggestive of a large indirect inguinal hernia containing peritoneal fat and extending into the scrotum with displacement of the right testis.

Previous open RIH repair with mesh completed 12mths prior found a moderate direct inguinal hernia; and during a post-op phone review (given the COVID pandemic) noted he was healing well. No urinary/obstructive or systemic symptoms identified. Other history included alpha thalassemia trait, ex-smoker and non-English speaking background (NESB).

Intraoperatively there was no evidence of recurrent hernia, and the mesh was intact; however a large right scrotal mass was identified as the cause. An 18x8cm soft lipomatous mass surrounded the right testicle and extended up towards the cord structures at the superficial inguinal ring. Given the concern for malignancy, a right orchidectomy and excision of scrotal mass was performed.

Histology confirmed a well differentiated grade 1 liposarcoma. He recovered well and is undergoing close MRI surveillance - with no sign of recurrence.

Discussion

Liposarcoma is an important differential for scrotal masses and can imitate an inguinoscrotal hernia on ultrasound, MRI is the gold standard investigation.

The above case highlights the importance of physical post-operative examination and barriers to care during the COVID pandemic, particularly in those with NESB. Informed consent was imperative, we could safely proceed with the appropriate surgery as the patient had been explicitly consented for testicular loss due to recurrent nature of the operation.