Muhammad Talat Mehmood, Farah Idrees, Muhammad Shahab Athar.
Paratesticular Rhabdomyosarcoma.
J Coll Physicians Surg Pak Jan ;12(3):185-6.

A 12 years old boy presented with a short history of right scrotal swelling following trauma. Ultrasound examination suggested right scrotal hematoma or testicular tumor. On exploration gross findings were suggestive of tumor with scrotal skin involvement for which right radical orchidectomy and hemiscrotectomy was performed. Biopsy and immunohistochemical analysis revealed paratesticular rhabdomyosarcoma.

Case Report: A 12 years old boy presented with a history of fall on a wooden bar sustaining injury to right scrotum 12 days back. Two days later he noticed swelling in right scrotum which was painful initially, but pain subsided spontaneously without medication. The swelling gradually increased in size which forced him to seek medical advice. The local examination revealed a large right scrotal swelling with skin adherent anteriorly at one place. It was firm and nodular with thickened spermatic cord. Left testis was normal. Provisional diagnosis of right scrotal hematoma or testicular tumor was made. Ultrasound examination showed a normal left testis and a large echopoor, homogenous mass below right testis suggestive of scrotal hematoma or tumor. On colour doppler scan, no vascularity was seen within the mass and para-aortic and iliac nodes were not enlarged. Liver was normal. Tumor markers (AFP, Beta-HCG and LDH) were within normal values. OPERATIVE PROCEDURE: Through the inguinal approach,vascular clamps were applied to the spermatic cord. An elleptical incision was made around tethered scrotal skin. A large 10x6 cms lobulated nodular, solid mass was found which on cutsection showed homogenous greyish white appearance. A right radical orchidectomy with high ligation of spermatic cord and hemiscrotectomy with primary skin closure was done. Histopathological examination revealed a well capsulated rhabdomyosarcoma. No normal testicular tissue was identified. Skin and spermatic cord margins were tumor free. Monoclonal antibodies (Vimentin and Desmin) were also positive for rhabdomyosarcoma. Postoperative recovery was uneventful. CT scan abdomen and pelvis as well as bone marrow biopsy were normal. Patient was referred to Peadiatric Oncology Department where he received one cycle of chemotherapy (VAC) and after which he did not turn up for further treatment and follow-up.

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