paratesticular liposarcoma

Background: Paratesticular liposarcoma is a rare entity, with dedifferentiated liposarcoma (DDLPS) representing the most aggressive subtype. Late recurrences with unusual patterns of spread have been documented but remain poorly characterized.Case presentation: We report a case of a 68-year-old male with a 10-year recurrence of paratesticular DDLPS following right orchiectomy. The patient initially underwent resection of a 5×4×4.5 cm paratesticular mass in 2015, with histopathology confirming DDLPS and negative distal spermatic cord margins. After loss to follow-up, he presented in 2026 with extensive regional recurrence involving bilateral pubic soft tissues, abdominal wall musculature, and right external iliac lymphadenopathy. Biopsy confirmed recurrent DDLPS with Mouse double minute 2 homolog (MDM2) positivity. Given the multi-site infiltrative nature and muscle involvement, the multidisciplinary team recommended neoadjuvant chemotherapy with ifosfamide and doxorubicin before consideration of surgical resection.Conclusion: This case illustrates the propensity for late regional recurrence in paratesticular DDLPS and highlights the unusual pattern of spread along anatomic pathways, including the abdominal wall and inguinal region. The case underscores the importance of long-term surveillance, aggressive initial surgical margins, and multidisciplinary management in this rare malignancy.