Incidental liposarcomas identified during hernia repair operations

Background and Objectives: Since the inguinal region communicates with the retroperitoneum, both retroperitoneal as well as de novo spermatic cord liposarcomas may be detected during hernia repair operations. We assessed the incidence of liposarcomas presenting at hernia repair in our hospital. Methods: We performed a clerical review of pathology reports on adult tissue accessioned during hernia repair operations and reviewed operating room logs to obtain information concerning the total number of hernia repair operations (since some operations afford no accessioned tissue). Results: Between 1992 and 1997, 1,736 adult hernia repair specimens were accessioned from approximately 2,000 operations. Among these, 22% had an associated cord lipoma; 2 cases were well-differentiated liposarcomas. These were from males aged 56 and 64 years in contrast to the mean age of 35 years for cord lipoma and measured 13 and 10 cm, whereas the mean size for cord lipomas was 5.5 cm. One of the liposarcomas had radiographic evidence of extension from a retroperitoneal lesion; the other appeared confined to the groin. On surgical exploration, the lesion was restricted to the spermatic cord region in both cases despite the suggestion of retroperitoneal extension/involvement in one. Conclusions: Incidental liposarcomas identified during hernia operations are rare (<0.1% at our institution) but their presence merits histologic evaluation of adipose tissue from these cases. However, if efforts to contain costs are implemented and histologic review of such tissue is deemed generally unrewarding, large (>10 cm) fatty masses from this area should still be sampled.