|Year : 2001 | Volume
| Issue : 2 | Page : 185-186
Paratesticular rhabdomyosarcoma in childhood
Gabriel Rodrigues, Annappa Kudva, Ananda Rao
Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India
Department of Surgery, Kasturba Medical College, Manipal (Karnataka) - 576 119
Source of Support: None, Conflict of Interest: None
Keywords: Rhabdomyosarcoma; Testis; Surgery
|How to cite this article:|
Rodrigues G, Kudva A, Rao A. Paratesticular rhabdomyosarcoma in childhood. Indian J Urol 2001;17:185-6
| Case Report|| |
A 15-year-old boy presented with a history of painless swelling in the left scrotum of 4-months' duration. On local examination, swelling of 10 x 12 cms on left side of the scrotum was found, which was cystic in consistency and fluctuant. Left spermatic cord was thickened and the testis could not be palpated separately. Examination of the right testis was normal. There was no inguinal lymphadenopathy and per abdominal examination was normal. Pre-operative diagnosis of a left primary vaginal hydrocele was made. On scrotal exploration, a secondary hydrocele with a tumour of 3x2 cms arising adjacent to the upper pole of the testis was found. Testis and spermatic cord were normal. Biopsy taken from the tumour revealed paratesticular rhabdomyosarcoma [Figure - 1]. Subsequent evaluation of the patient did not reveal any evidence of metastasis. A left high inguinal orchidectomy with hemiscrotectomy [Figure - 2] was performed and post-operative chemotherapy was given. He remains asymptomatic 3-months' postoperatively and later was lost for follow-up.
| Discussion|| |
Rhabdomyosarcoma is one of the ten most common childhood malignancies. The genitourinary tract, especially paratesticular structure is a frequent location for this rare and lethal tumour.
Paratesticular sarcomas usually arise adjacent or slightly more superior to the testis, from the intrascrotal portion of the cord and less commonly they are located in the inguinal canal. Their superficial location facilitates an earlier diagnosis and their differentiation from the much more common inguinoscrotal hernias, hydroceles and spermatoceles is of utmost importance.
This is predominantly a tumour of the adolescents with median age of 15 years. Generally the tumour at this site manifests as a unilateral, firm, painless mass that has been present for few weeks or months and are usually located at the upper pole of testis. They may also involve the spermatic cord and the epididymis but usually are separate from the testis proper. There is a high incidence of retroperitoneal or para aortic lymph node involvement, a feature that is easily overlooked and must be considered while planning for therapy.
Children with non-infiltrating tumours are curable and radical orchidectomy with adjuvant radiation or preferably chemotherapy is adequate for these patients. Conversely in those children with infiltrative tumours, retroperitoneal nodal metastasis invariably develops. Early retroperitoneal lymphadenectomy with adjuvant radiation and multidrug cyclic chemotherapy is life saving. In this patient, since it was an early lesion without local infiltration and distant metastasis, left high inguinal orchidectomy with hemiscrotectomy was done and postoperative chemotherapy given to prevent recurrence.
| References|| |
|1.||Alberes - Saavedra J. Rhabdomyosarcoma. Prog Clin Cancer 1965; 1: 683. |
|2.||Hoffman WW, Baird SS. A rare tumour of the spermatic cord: Rhabdomyosarcoma. J Urol 1960; 84: 376. |
|3.||Malek RS, Kelalis PP. Paratesticular rhabdomyosarcoma in childhood. J Urol 1977: 118: 450-453. |
[Figure - 1], [Figure - 2]