Primary Leiomyosarcoma of the Scrotum in Bujumbura: A Case Report and Literature Review

Abstract

Background: Leiomyosarcoma of the scrotum is an exceedingly rare malignant tumor of mesenchymal origin, typically arising from the smooth muscle of the spermatic cord, epididymis, or dartos layer. Its diagnosis remains challenging due to its clinical similarities to other intrascrotal masses. Case Presentation : We report the case of a 59-year-old man with a painless, progressive right scrotal mass, managed at the Bujumbura Central Polyclinic. Ultrasound revealed a well-defined, vascularized paratesticular mass. Surgical excision through right scrototomy was performed with preservation of the testis. Histological analysis confirmed a high-grade leiomyosarcoma (grade III for the tumor grading system of the National Federation of Cancer Centers (NFCC)) with negative margins. A thoraco-abdomino-pelvic (TAP) computed tomography (CT) scan performed three months postoperatively was normal. No adjuvant therapy was given. Clinical and imaging follow-up showed no recurrence or metastasis at three months. Discussion: Paratesticular leiomyosarcoma represents a small subset of genitourinary sarcomas. Scrotal leiomyosarcoma is particularly rare, and its clinical course and prognosis remain poorly defined. Histological confirmation is essential, and surgical excision with negative margins remains the cornerstone of treatment. Orchiectomy is the gold standard for the spermatic cord, intratesticular and epididymal forms, while lumpectomy maybe appropriate for purely scrotal tumors. The role of radiotherapy and chemotherapy remains uncertain in non-metastatic disease. Close clinico-radiological follow-up is recommended due to the risk of recurrence. Conclusion: This case highlights the diagnostic and therapeutic challenges of primary scrotal leiomyosarcoma, especially in resource-limited settings. Early surgical management with histopathological confirmation is essential for favorable outcomes.