PARATESTICULAR RHABDOMYOSARCOMA IN THE PEDIATRIC POPULATION – CASE REPORT
DOI:
https://doi.org/10.46793/PP251124020MKeywords:
paratesticular rhabdomyosarcoma, surgery, chemotherapy, pediatricsAbstract
Introduction: Paratesticular rhabdomyosarcoma is a rare and aggressive intrascrotal tumor. Its superficial localization allows for early detection, an adequate diagnostic approach, and timely therapy, all of which are associated with a favorable outcome.
Case outline: We present the case of a 13-year-and-2-month-old boy with a painless tumor mass in the left hemiscrotum, present for approximately two months prior to admission. He had no symptoms until 2–3 days before admission, when pain in the left hemiscrotum occurred during physical activity. No other complaints were reported. Initial evaluation included a scrotal ultrasound, which showed heteroechoic paratesticular tumor change of the left testis. MRI of the scrotum and pelvis, performed both natively and post-contrast, revealed a spherical, expansive extratesticular lesion located between the testis, which it displaced cranially, and part of the epididymal tail, which it displaced caudally. The lesion measured 35 mm × 36 mm × 37 mm. Laboratory findings, including tumor markers (beta-hCG, alpha-fetoprotein and LDH), were within physiological limits. Additionally, abdominal ultrasound, chest X-ray and the chest CT showed no pathological changes. Following the decision of the oncology board, a radical orchiectomy with complete excision of the paratesticular tumor mass was performed. Histopathology with immunohistochemistry confirmed a high-grade primary malignant mesenchymal tumor with rhabdomyoblastic differentiation, consistent with rhabdomyosarcoma. Accordingly, chemotherapy was initiated following the standard IVA regimen used in Europe (Ifosfamide, Vincristine, Actinomycin).
During the 2-year follow-up period from the end of treatment, the patient showed no signs of recurrence of the underlying disease.
Conclusion: Paratesticular rhabdomyosarcoma most commonly presents similarly to other intrascrotal tumors. Due to its aggressiveness and tendency for rapid spread, early diagnosis and treatment are essential. Multimodal therapy—including surgery, chemotherapy, and occasionally radiotherapy—improves survival prospects and contributes to a more favorable outcome.
References
Ahmed HU, Arya M, Muneer A, Mushtaq I, Sebire NJ. Testicular and paratesticular tumours in the prepubertal population. Lancet Oncol. 2010;11(5):476-83. doi: 10.1016/S1470-2045(10)70012-7
Lawrence W Jr, Hays DM, Heyn R, Tefft M, Crist W, Beltangady M, et al. Lymphatic metastases with childhood rhabdomyosarcoma. A report from the Intergroup Rhabdomyosarcoma Study. Cancer. 1987;60(4):910-5. doi: 10.1002/1097-0142(19870815)60:4<910::aid-cncr2820600433>3.0.co;2-8
Dangle PP, Correa A, Tennyson L, Gayed B, Reyes-Múgica M, Ost M. Current management of paratesticular rhabdomyosarcoma. Urol Oncol. 2016;34(2):84-92. doi: 10.1016/j.urolonc.2015.10.004
Faure A, Diakité ML, Panait N, Chaumoître K, Rome A, Merrot T. Paratesticular rhabdomyosarcoma in children: a scrotal emergency. Arch Pediatr. 2012;19(12):1340-4. French. doi: 10.1016/j.arcped.2012.09.022
Guennouni A, Abourak C, Bahha S, Esseti S, El Haddad S, Allali N, et al. Uncommon Pediatric Case: Rhabdomyosarcoma With Ipsilateral Testicular Invasion. Sage Open Pediatr. 2025;12:30502225251346270. doi: 10.1177/
Bouchikhi AA, Mellas S, Tazi MF, Lahlaidi K, Kharbach Y, Benhayoune K, et al. Embryonic paratesticular rhabdomyosarcoma: a case report. J Med Case Rep. 2013;7:93. doi: 10.1186/1752-1947-7-93
Merks JHM, Brack E, Ebinger M, Minard-Colin V, Defachelles AS, Hladun R, et al. European standard clinical practice recommendations for children and adolescents with Rhabdomyosarcoma a joint EpSSG, CWS and ERN PaedCan project. EJC Paediatr Oncol. 2025;5:100229.
