Paratesticular Embryonal Rhabdomyosarcoma; Report of a Case

Background: Paratesticular rhabdomyosarcoma is the most common pediatric soft-tissue sarcoma, often presenting in the first two decades after birth. Paratesticular embryonal rhabdomyosarcoma (RMS) is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. It represents only 7% of all patients entered in the Intergroup Rhabdomyosarcoma Study (IRS) and 17% of all malignant intrascrotal tumors in children less than 15 years old.
Case Presentation: We report a case of a 14-year-old boy with a left paratesticular tumor, who undergone inguinal surgery and misdiagnosed as being inguinal hernia. During operation, the surgeon realized that the mass was not an inguinal hernia, it seemed like a testicular tumor. A urologist was consulted. The patient underwent left high inguinal orchiectomy. His serum markers for α-fetoprotein, β-human chorionic gonadotropin and lactate dehydrogenase were normal. In the result of further investigation, the patient was diagnosed as having paratesticular embryonal rhabdomyosarcoma with retroperitoneal lymph node mass. We referred him to the oncology department. The patient was followed up post-operatively with chemotherapy. Vincristine, doxorubicin and cyclophosphamide (VAC) regimen was used. One year after completion of chemotherapy there was no evidence of the disease.
Conclusion: In the patients with testicular and paratesticular mass, ultrasound should be considered the imaging modality of choice for evaluating intra-scrotal pathologies in adolescents.