Congreso Virtual sobre Anatomía Patológica

832. Comunicación libre

Leimiosarcoma escrotal del músculo Dartos.

Fernando Terrasa Sagristá[1], María Margarita Company Campins[1], Javier Ibarra de la Rosa[1], Francisca Salvá Ramonell[1]
(1) Hospital Son Llàtzer. Palma de Mallorca. ESPAÑA

Resumen

T-SIZE: 12pt; FONT-FAMILY: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: ES; mso-fareast-language: ES; mso-bidi-language: AR-SA">Los leiomiosarcomas del escroto, sin implicación testicular, epididimal o del cordón espermático, son raros. Son tumores que provienen del músculo dartos de la piel del escroto. Se presentan como masas de crecimiento lento, no doloroso que protuyen el la pared escrotal. Sólo existen 29 casos descritos en la literatura. Presentamos un nuevo caso

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Introduccion    

Los leiomiosarcomas representan aproximadamente el 30% de los sarcomas paratesticulares en adultos. Macroscópicamente aparecen como masas sólidas de consistencia elástica de coloración gris-parduzca. Microscópicamente se caracterizan por una proliferación de haces entrelazados de células con amplio citoplasma eosinófilo y núcleo con bordes romos, dispuestos de forma paralela y con vacuolas perinucleares. Pueden presentar una variabilidad histológica tremenda desde los bien diferenciados, difíciles de distinguir de un leiomioma a los pleomórficos y bizarros con apariencia sarcomatoide que requieren inmunohistoquimia para intuir su estirpe celular. Los leiomiosarcomas del escroto provienen del músculo dartos, son muy infrecuentes y deben diferenciarse de los leiomiomas con células bizarras o monstruosas, similares a los descritos en el miometrio. Su tratamiento es la extirpación completa con márgenes amplios con posibilidad de añadir radioterapia para evitar posibles recidivas.

 

Resultados    

CASO

Paciente varón de 84 años que acude a la consulta de cirugía para valoración de lesión péndula no dolorosa en escroto izquierdo que ha crecido en los últimos meses. Clínicamente es una lesión de bordes lisos que mide aproximadamente 3 cm, de consistencia blanda con apariencia de lipoma o quiste epidérmico.

La pieza de extirpación consistió en una lesión nodular de bordes bien definidos, consistencia elástica y coloración blanco-amarillenta que midió 3.7x3.5 cm. (fig 1)

En los cortes de parafina se observó una proliferación fusocelular, de haces entrelazados constituidos por células con citoplasmas amplios eosinófilos, núcleos de bordes romos en “cigarro puro” con pseudoinclusiones intranucleares eosinófilas y abundantes células monstruosas, alguna de las cuales presentaba multinucleación. Se identificaron 2 mitosis en diez campos de gran aumento. No se evidenció necrosis ni hemorragia. Se confirmó el diagnóstico de leiomiosarcoma con la inmunopositividad de las células neoplásicas a vicentina, desmina y actina. La tumoración distaba 3 mm del margen profundo, por lo que se planteó la posibilidad de ampliación de márgenes o radioterapia, que se rechazó por el mal estado general del paciente.

Tras 4 meses después de la exéresis no hay evidencia de recidiva local ni metástasis.

 

fig 1 - <div style=fiogf49gjkf0dFoto macroscópica: masa sólida de consistencia elástica.">
fig 1 -

fiogf49gjkf0d
Foto macroscópica: masa sólida de consistencia elástica.


fig.2 - <div style=fiogf49gjkf0dMicrofotografía panorámica de la biopsia del escroto.">
fig.2 -

fiogf49gjkf0d
Microfotografía panorámica de la biopsia del escroto.


Fig 3 - <div style=fiogf49gjkf0dÁrea hipocelular del leiomiosarcoma con áreas de colagenización.">
Fig 3 -

fiogf49gjkf0d
Área hipocelular del leiomiosarcoma con áreas de colagenización.


fig 4 - <div style=fiogf49gjkf0dArea hipercelular con marcada atipia celular y pleomorfismo.">
fig 4 -

fiogf49gjkf0d
Area hipercelular con marcada atipia celular y pleomorfismo.


fig 5 - <div style=fiogf49gjkf0dPresencia de células monstruosas con inclusiones citoplasmáticas intranucleares.">
fig 5 -

fiogf49gjkf0d
Presencia de células monstruosas con inclusiones citoplasmáticas intranucleares.


fig 6 - <div style=fiogf49gjkf0dDetalle de una mitosis.">
fig 6 -

fiogf49gjkf0d
Detalle de una mitosis.


Fig 7 - <div style=fiogf49gjkf0dDetalle de una mitosis tripolar.">
Fig 7 -

fiogf49gjkf0d
Detalle de una mitosis tripolar.


fig 8 - <div style=fiogf49gjkf0dPositividad para la inmunotinción de actina">
fig 8 -

fiogf49gjkf0d
Positividad para la inmunotinción de actina




Conclusiones    

El leiomiosarcoma del escroto, es raro, con apenas una treintena de casos publicados. Suelen presentarse entre la cuarta la octava década, como una masa de crecimiento lento, no dolorosa. Se han descrito varios casos de recurrencia local y metástasis en pacientes con leiomiosarcoma de escroto. El diagnóstico diferencial principal es con el   leiomioma de células monstruosas del escroto, que a diferencia del leiomiosarcoma no presenta áreas hipercelulares ni mitosis.

 

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