Imaging Findings of Angiomyxolipoma of the Spermatic Cord Mimicking Inguinal Hernia
A 72-year-old man presented with a 1 month history of a painless palpable mass in the right inguinal region. On physical examination, an irreducible tender mass was detected in the right inguinal region. Laboratory data were within normal ranges. A clinical diagnosis was made of a right inguinal hernia. The inguinal US revealed an oval shaped, mixed echogenic mass () with a focal area of slightly increased vascularity on a color Doppler image. A longitudinal scan showed a hyperechoic area on the superficial one-fifth region, a linear structure on the intervening portion, and a mixed echoic area on the deep four-fifth region of the mass (). There was no evidence of a herniated bowel loop or omental fat. Contrast enhanced multi-detector (MD) CT demonstrated an approximately 9.8 × 5.3 cm well-defined elongated, homogeneously low attenuated mass without an enhancing portion attached to the right spermatic cord and extending to the right inguinal subcutaneous region (). The axial image showed the focal fat density area without an enhancing portion, on the anterior peripheral portion of the mass (). There was no radiographic evidence of any regional lymph node involvement or invasion involving a contiguous structure on CT scan. Preoperative diagnosis of benign soft tissue tumor of the spermatic cord was suggested because the imaging appearances were not compatible with inguinal hernia or inguinal hydrocele.\nUpon inguinal exploration for this suspected soft tissue mass, a 10 × 6 cm soft gelatinous mass was discovered which was adherent to the spermatic cord but simultaneously mobile and free from attachments with other soft tissue elements. The spermatic cord coursed through this mass. Upon closer inspection there was no evidence of a hernia or laxity in the posterior wall of the inguinal canal. The patient underwent excision of the mass without hernia repair surgery.\nThe histopathologic findings showed a well-demarcated, myxoid neoplasm comprised of spindle and stellate cells, mixed with mature adipocytes and numerous thin- and thick-walled vessels of various sizes (). Immunohistochemically, the cells of the myxoid areas were positive for CD34 () but not for S-100 protein, desmin, or smooth muscle actin (SMA). The mature adipocytes were focally positive for S-100 protein (). The CD34 and SMA highlighted vascular endothelial cells and perivascular smooth muscle fibers, respectively (). The tumor was negative for desmin (). On the basis of these findings, angiomyxolipoma was diagnosed.