Primary intratesticular rhabdomyosarcoma: A case report and literature review

Abstract

Rhabdomyosarcoma (RMS) that primarily occurs in the testes is particularly rare, with only retrospective studies and sporadic cases reported in the literature. The present study describes the case of a large, primary intratesticular RMS (ITRMS) that was treated with a radical inguinal orchiectomy (RIO) and a regimen of chemotherapy. The study also presents a review of the literature regarding primary ITRMSs, aiming to elucidate the clinical characteristics and optimal treatment of the disease. A 14-year-old male presented with a 1-year history of a slow-growing, painless, left scrotal mass. Magnetic resonance imaging identified a mass in the left scrotum with mixed signal intensity; no abnormal signals were identified in the right testicle and retroperitoneal lymph node. An X-ray of the chest demonstrated no evidence of metastasis. Subsequent to this, a left RIO was performed. Histopathological and immunohistochemical examination confirmed the final diagnosis of embryonal ITRMS. At 21 days post-surgery, an ¹⁸F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan identified widespread metastatic lesions in the lungs, local lymph nodes and bones, presenting as increased glucose metabolism nodules. Subsequently, the patient received six sequential cycles of adjunct chemotherapy. The patient is alive with disease in October 2015. The case described is noteworthy as it is an example of ITRMS, in which the patient received successful treatment. However, multidisciplinary treatment may further improve the outcome of the disease.

Keywords: intratesticular rhabdomyosarcoma; metastasis; orchiectomy; prognosis.

Figure 1.

Magnetic resonance imaging scan demonstrating a left scrotal mass with a mixed signal, consisting of isointensity on T1-weighted images and high signal on T2-weighted images, with no abnormal signal identified in the right testicle and epididymis.

Figure 2.

Histological section in which viable tumor cells, primarily round and spindle cells, were identified to contain eccentric nuclei and deeply eosinophilic cytoplasm. Hematoxylin and eosin staining; magnification, ×100.

Figure 3.

Positron emission tomography/computed tomography scans demonstrating complete remission of the pulmonary lesion and partial remission of the retroperitoneal lesion in response to chemotherapy. (Aa) Arrows indicate retroperitoneal lymphodonus metastasis in pre-chemotherapy. (Ab) Arrows indicate retroperitoneal lymphodonus metastasis in post-chemotherapy. (Ba) Arrows indicate the pulmomary lesion in pre-chemotherapy. (Bb) Post-chemotherapy in the pulmonary lesion.