226 Park et al FIG. 1. Computed tomography scan showing a 3.2 cm lobulated mass in the left inguinal area (A) and a hydrocele in the left scrotum (B). FIG. 2. On gross examination, the left orchiectomy specimen was composed of a 5.0x6.0 cm sized testis, attached to a 12 cm length spermatic cord and detached tunica vaginalis hydrocele sac. At the spermatic cord, there was a nodular mass measuring 5.0x3.2 x2.5 cm. The outer surface of the mass was relatively well capsu- lated and the cut surface was shiny and whitish. large one and 0.5x0.2x0.3 cm in the small one. Microscopi- cally, the spermatic cord mass and peritoneal nodules were relatively well demarcated and desmoplastic. The mass was composed of foci of epithelial tumor cells with mostly tubular or papillary patterns and obvious sarcomatous tu- mor cells. The tumor cells showed high-grade nuclei and atypical mitotic figures (3-4/10 HPF) (Fig. 3). The epithelial and sarcomatoid tumor cells were immunoreactive to cyto- keratin, calretinin, vimentin, and mesothelial antibody Korean J Urol 2011;52:225-229 (HBME-1) but were not reactive to carcinoembryonic anti- gen (CEA) (Fig. 4). The peritumoral resection margin was partially penetrated by the tumor. The cord resection mar- gin was free of tumor. No lymphovascular invasion was seen. The testicular parenchyma was unremarkable. All of these findings were compatible with MM arising from the left spermatic cord. 　We recommended that the patient be managed further with pelvic lymphadenectomy and adjunctive chemo- therapy, which he refused. At 3 months after the operation, he returned to our outpatient department with the com- plaint of abdominal bulging and discomfort. On the phys- ical examination, the abdomen showed marked bulging. The following CT showed a 1.8 cm oval-shaped nodule in his right inguinal area, which suggested MM arising from the contra-lateral spermatic cord. Also, he had peritoneal carcinomatosis with a large amount of ascitic fluid collec- tion, peritoneal thickening, misty mesentery, and a cen- tralization of the small bowel. He was referred to our hema- to-oncology department for cisplatin-based intraperito- neal chemotherapy. He underwent one cycle of chemo- therapy with some improvement. He died 6 months after the operation. DISCUSSION Paratesticular MMs are distributed over a wide age (range, 7-87 years), but mostly occur in patients in the sixth to eighth decades of life [4]. Most paratesticular MM arises in the tunica vaginalis [4,5], a peritoneal outpouch of the abdominal cavity. Usually, the tumor presents as a para- testicular mass, such as a hydrocele or intrascrotal mass of unknown origin. In Plas et al’s review, the most fre- quently presented symptom was scrotal enlargement with