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+We present the case of a 65-year-old man who consulted the emergency department in August 2005, presenting with urinary pain in the hypochondrium and right inguinal region of 72 hours' evolution, fever, general malaise and irritative urinary symptoms.
+She had a history of hypertension and diabetes mellitus 2 under treatment, her mother had breast cancer, her father had coronary heart disease and her sister had a brain tumour.
+On admission to the emergency department she had blood pressure (BP): 130/80, heart rate (HR): 80 beats per minute, respiratory rate (RR): 18 breaths per minute, temperature (T): 38.7 degrees Celsius (oC), with no signs of respiratory distress. In the neck there was a thyroid mass measuring 4 x 6 cm, indurated, not very mobile, not painful on palpation, with no inflammatory changes.
+Physical examination revealed a large mass in the right flank and iliac fossa which continued to the inguinoscrotal region, displacing the left hemiscrotal and penis, with no evidence of inguinal adenopathy or local inflammatory changes, the mass had a firm, hard consistency, non-mobile, with negative transillumination; the right testicle was not palpable due to the mass effect, the left testicle was present, rectal examination was unremarkable.
+The patient presented with pain on right lumbar percussion and urinary tract infection was confirmed by urine culture; intravenous antibiotic treatment was started. Lactate dehydrogenase dehydrogenase (LDH) levels were measured and the result was 300 U/L.
+During her hospitalisation she presented hyperglycaemia (259 mg/dl), normal creatinine (0.8 mg/dl), leucocytes 17850 neutrophils 86% haemoglobin 16 platelets 275 000. After antibiotic management, signs of systemic inflammatory response decreased.
+A contrasted abdominal tomography (CT) scan (September 2005) showed the presence of a large mass in the right iliac fossa that displaced the bladder to the contralateral side and continued to the right hemiscrotal, solid in appearance, with well-defined borders, diffusely involving the ipsilateral testicle. There was no evidence of locoregional adenopathy.
+The tumour was excised together with a radical orchidectomy on the same side of a semi-ovoid, lobulated, yellowish, smooth-surfaced mass measuring 34 x 22 x 17 cm and weighing 5786 grams. Complete removal was achieved without complications, the patient presented good clinical evolution post-surgery and it was therefore decided to discharge the patient on the 5th day post-surgery.
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+The pathology report confirms that the tumour lesion corresponds to a malignant neoplasm of mesenchymal and sarcomatous origin formed by well-differentiated adipose cells in the middle of which some bizarre pleomorphic cells are observed, constituting a dominant picture of well-differentiated liposarcoma, lobulations of cartilage-like tissue are observed, which corresponds to a component of the divergent tumour, where there is cartilage-like tissue with a malignant hyaline tumoural appearance that oscillates between a grade II and III chondrosarcoma component. The tumour corresponds to a dedifferentiated liposarcoma in which the adipose component is a classic well-differentiated lipoma-like liposarcoma from which islands of high-grade chondrosarcoma component emerge, such findings corresponding to dedifferentiated liposarcoma of the spermatic cord with tumour-free resection margins.
+Local radiotherapy was suggested but the patient refused, accepting only periodic clinical check-ups. During the follow-up, an aspiration cytology of the cervical mass was performed and the pathology report showed papillary thyroid carcinoma, which is currently being followed up by oncology. Forty-eight months after excision of the inguinoscrotal mass, the patient is asymptomatic, with no clinical or paraclinical signs of tumour recurrence.
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