Pleomorphic rhabdomyosarcoma of the spermatic cord and a secondary hydrocele testis: A case report

Abstract

Background: Pleomorphic rhabdomyosarcoma (RMS) of the spermatic cord is a group of rare neoplasms, and a secondary hydrocele testis occasionally occurs. The misdiagnosis of paratesticular mass may lead to a therapeutic delay.

Case summary: A 79-year-old man presented to our clinic complaining of a 1-mo history of painless scrotal swelling. Physical examination revealed approximately a 15 cm × 10 cm × 5 cm inguinal mass with limited mobility. Contrast-enhanced magnetic resonance imaging showed a hydrocele testis, several enlarged inguinal lymph nodes, and a heterogeneously enhanced lesion with a relatively well-defined margin in the left inguinal region. Due to the imaging findings, he was diagnosed with pleomorphic RMS and received a wide resection of the mass, an inguinal incision with a high section of the left spermatic cord, and a left radical orchiectomy. He experienced local relapse 1 mo postoperatively and received radiotherapy and anlotinib hydrochloride-based immunotherapy as adjuvant therapy. The patient died 3 mo after the surgery.

Conclusion: The optimal interventions for advanced-stage pleomorphic RMS patients should be investigated by more preclinical studies and clinical trials. Physicians need to be aware of the occurrence of pleomorphic RMS in unusual locations, especially when accompanied by a hydrocele testis.

Keywords: Case report; Pleomorphic rhabdomyosarcoma; Secondary hydrocele testis; Spermatic cord.

Figure 1

Physical examination. A left scrotal mass measuring 15 cm was noted.

Figure 2

Intraoperative finding. A and B: Coronal (A) and sagittal (B) views of contrast-enhanced magnetic resonance imaging showing a hydrocele testis and a heterogeneously enhanced lesion with a relatively well-defined margin; C: Intraoperative finding of the spermatic cord tumor and a secondary hydrocele testis.

Figure 3

Histopathological and immunohistochemical analyses. A: Formalin-fixed paraffin-embedded tumor tissue was stained with hematoxylin and eosin (100 ×); B: Vimentin (200 ×, cytoplasmic and membranous staining); C: Desmin (200 ×, cytoplasmic staining); D: Myogenin (200 ×, nuclear staining); E: Smooth muscle actin (200 ×, cytoplasmic and membranous staining); F: Ki-67 (200 ×, approximately 40% positivity).