Paratesticular rhabdomyosarcoma in young adults: A tertiary care institute experience

Extratesticular masses focusing on MRI findings

Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI.

Treatment results of Para-Testicular Rhabdomyosarcoma (PT-RMS) using radiation as an alternative to retro-peritoneal nodal dissection: A single Institution experience

BACKGROUND

Para-testicular Rhabdomyosarcoma (PT-RMS) has a favorable treatment outcome adopting multidisciplinary management; resection, namely high inguinal orchiectomy ± retro-peritoneal lymph node dissection (RPLND) followed by standard or intensive chemotherapy ± adjuvant radiation therapy.

PATIENTS AND METHODS

This is a retrospective study including all patients with pathologically proven PT-RMS, presented to the National Cancer Institute, Cairo University, during the period from 2005 to 2020. Endpoints included overall survival, disease free survival and patterns of failure of different treatment modalities.

RESULTS

Forty one patients were identified. Median age in our cohort was 15 years (range: 2-54 years). After a median follow up of 26 months (range, 3-75 months) ,two and five years OS were 100% and 91.7% respectively and median survival was not reached. Patients who underwent retro-peritoneal nodal dissection had a 5-year DFS rate of 100% versus 73% for those who received radiation to para-aortic nodes (p = 0.185). Limitations include retrospective nature and deviation from COG protocol.

CONCLUSIONS

This study shows promising results suggesting that less aggressive local treatment modalities including radiation to para-aortic chain could be an option in PT-RMS, given the excellent results of this subtype. However further validation in a prospective study is warranted.

Baseline Characteristics, Prognostic Factors, and Treatment Outcomes for Adult Patients With Rhabdomyosarcoma (RMS)

BACKGROUND

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood, while in adults it is one of the rarer tumors. Its prognosis is better in children with current treatment modalities; however, it carries poorer prognosis in adults. Recent data on adult RMS is scarce from our part of world. We report outcomes of adult patients with RMS, and with 40 patients; it is the first study to publish such a large data from Pakistan.

METHODS

This was a retrospective study that included 64 adult patients aged 18 years and older. After data extraction and scrutiny, a total of 40 patients were segregated with diagnosis of RMS of various varieties who were treated and followed up subsequently. International Business Machines (IBM) Statistical Package for Social Sciences (SPSS), version 26 (IBM Corp., Armonk, NY) was used to evaluate all of the gathered data.

RESULTS

Embryonal RMS (ERMS) was the most common subtype. Factors favoring better overall survival (OS) at 5 years were absence of nodal and distal metastases, treatment with surgery, margin negative resection, and absence of residual disease on postoperative imaging. Adjuvant radiation therapy (XRT) for positive resection margins as well as for residual disease on postoperative imaging also favored better OS at 5 years. Chemotherapy did impart a trend towards better OS; however, it was not significant. Histopathologic subtype and tumor size did not have any significant impact on outcomes. Median progression free survival (PFS) was 11 months and median OS was 15 months.

CONCLUSIONS

Adult RMS is a rare disease entity with widely heterogeneous clinical picture and poorer outcomes as compared to the disease of childhood and adolescence. Further prospective studies with larger sample size are required to establish role of patient, disease, and treatment-related factors affecting outcomes in our population.

Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India

OBJECTIVE

Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period.

METHODS

All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details.

RESULTS

A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma.

CONCLUSION

PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.

Radiologic Pathologic Correlation of Primary Paratesticular Rhabdomyosarcoma

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and adolescence, arising from the mesenchymal tissue. It is an intrascrotal tumor localized in the paratesticular structures such as the epididymis or spermatic cord. The majority of this tumor occurs in the first two decades of life. Ultrasound is considered the imaging modality of choice for evaluating an intra-scrotal abnormality. We present a case of a 4-year-old boy with a 2-weeks history of rapidly increasing left scrotal swelling which was clinically diagnosed as hydrocoele. We present the ultrasound, elastography and MRI features of a case of paratesticular embryonal rhabdomyosarcoma with pathologic correlation and also emphasize need to consider sarcoma as a differential diagnosis for rapidly growing scrotal swelling.

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

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.

Role of magnetic resonance imaging in the early diagnosis of paratesticular rhabdomyosarcoma

INTRODUCTION

Paratesticular lesions are common, and one subgroup is paratesticular rhabdomyosarcoma. The latter is a relatively uncommon (but aggressive) tumour that affects children and adolescents predominantly. Ultrasound is the first-line investigation, but can be inconclusive. Magnetic resonance imaging (MRI) can provide useful information, but its role in the diagnosis of rhabdomyosarcoma is not clear.

CASE HISTORY

We report a 17-year-old male who presented with a one-month history of a rapidly enlarging, non-tender, lump in the right testicle. Urgent ultrasound of the scrotum revealed a heterogenous paratesticular mass that was hypervascular and showed calcification in the right inguinal area. MRI of the pelvis showed a solid, enhancing lesion of dimension located superior to the upper pole of the right testes and a slightly heterogeneous T2 signal, but was homogenous post-contrast. The patient underwent right radical orchidectomy, and histology results were assessed. He received chemotherapy and is being followed up.

CONCLUSIONS

Improvements in imaging in addition to early surgical intervention and chemotherapy treatment are crucial to improve survival chances against rhabdomyosarcoma. Ultrasound findings for benign diseases may mimic those seen in rhabdomyosarcoma. In such cases of diagnostic uncertainty, our surgical team suggest MRI to reduce the risk of a delayed diagnosis and time to treatment.

Paratesticular rhabdomyosarcoma in young adult- a case report

Para testicular rhabdomyosarcoma is a rare malignant tumour, which usually presents as a painless mass in the scrotum or groin. A case of para testicular rhabdomyosarcoma in a 17-year-old male is being reported here who presented with chronic scrotal pain. Paratesticular rhabdomyosarcoma is a rare non germ cell tumour of scrotal sac in children and young adult/teens which can invade testis at presentation. Embryonal variant is the most common type. 40% cases can have metastasis to retroperitoneal lymph node. Diagnosis can be done on high degree of clinical suspicion coupled with biopsy and immunohistochemistry. Multimodality approach of treatment is often beneficial for patients.