Localized Inflammatory Presentation of Scrotal Tumour

Paratesticular tumours are rare tumours reported in literature. Their clinical behaviour and presentation sometimes makes the clinician to misdiagnose. Our aim to present the case of old man with masked presentation of scrotal sarcoma, admitted to the medical ward due to the symptoms of cough, unwitnessed fall, pressure sores on sacral areas and scrotal swelling. On chest X ray blunting of right costo-phrenic angle and left sided consolidation. Blood sciences showed the normal picture apart from the raised CRP. Urine dipstick showed did not show any signs of infection. The initial treatment was based on managing the sepsis with full treatment protocol. Ultrasound showed a large heterogenous mass within the right scrotum appears to be separated from right testis. Size of both testes was normal. The diagnosis of scrotal abscess was made and treated by incision and drainage. The patient died after four weeks. The initial provisional histological report suggesting presentation of necrotic areas as abscess rather than coagulative tumour necrosis, favouring a reactive myofibroblastic lesion. The final histological diagnosis stated as de-differentiated liposarcoma grade 2. It is also interested to report that the patient was seen by the urology team nearly two years before this admission for the same swelling, and he was offered orchidectomy, but the patient declined the treatment. In conclusion, paratesticular tumors are rare tumours, accounting for almost 1- 2% of soft tissues sarcomas of genitor urinary tract. These tumors show the high potential for malignancy. It could not be excluded that the findings found on the patient’s chest X-rays were the malignant focus of the primary scrotal tumour. More information is needed to evaluate the clinical behavior of these types of tumour, due to their masking presentation, especially in old age group of patients.