Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report

Journal of Medical Case Reports

Case Report

Ghada Sahraoui¹  Khaled Rahal²  Maher Slimane²  Amani Jallali²  Riadh Chargui²  Jamal Ben hassouna²  Takoua Chalouati²  Montassar Ghalleb² 

[1] Histology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia;Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia;Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia;Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia;

关键词: Paratesticular rhabdomyosarcoma;    Paraaortic lymph nodes;    Surgery;   

DOI  :  10.1186/s13256-022-03707-x

 received in 2022-08-08, accepted in 2022-12-02,  发布年份 2022

来源: Springer

【 摘 要 】

IntroductionParatesticular rhabdomyosarcoma is a rare and aggressive mesenchymal tumor, accounting for only 7% of all rhabdomyosarcomas. It is mainly encountered in children and adolescents. The standard treatment consists of radical orchidectomy with negative surgical margins. However, chemotherapy is recommended to control retroperitoneal micrometastasis. The place of surgery for progressive retroperitoneal lymph node metastases remains controversial. We present a case of paratesticular rhabdomyosarcoma with progressive retroperitoneal lymph node metastases treated with surgery.Case reportWe report a case of a 17-year-old North African male with no particular medical history who presented with a left scrotal mass that had been evolving for several months. Beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase were normal. Scrotal ultrasonography revealed the presence of a 6 cm heterogeneous hypoechogenic tissular mass with cystic areas adherent to the left scrotal wall, which was thickened in some places and vascularized by color Doppler. It exerted a mass effect on the homolateral testicle, which was of average volume. The thoracic–abdominal–pelvic computed tomography scan showed the presence of suspicious paraaortic lymph nodes. The most voluminous one measured 16 × 23 mm2. A left orchidectomy was performed. The final pathology report revealed an 8 cm paratesticular rhabdomyosarcoma of the embryonic type that displaced the testicle without invading it. Without going beyond it, it infiltrated the epididymis, the rete testis, and the albuginea. The surgical margin at the level of the spermatic cord was free. The patient had adjuvant chemotherapy (ifosfamide, vincristine, and dactinomycin). The patient had a challenging paraaortic lymph node dissection since the mass enlaced the left ureter and renal vessels. On histological examination, the paraaortic lymph nodes were metastatic.ConclusionRhabdomyosarcoma is an aggressive malignancy with high metastatic potential. Therefore, only an accurate diagnosis and early treatment can ensure better survival. Surgery in expert hands seems to be a good option for progressive retroperitoneal nodes. However, further studies are needed to determine the place of surgery in this setting.

【 授权许可】

CC BY   
© The Author(s) 2022

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