Report of a Rare Case of Childhood Paratesticular Rhabdomyosarcoma (PT-RMS) and Literature Review

Suci  Pratiwi; Nency  Erlina

doi:10.54783/ijsoc.v7i2.1459

Suci Pratiwi Marthen Indey Army Hospital, Jayapura, Indonesia
Nency Erlina Marthen Indey Army Hospital, Jayapura, Indonesia

DOI: https://doi.org/10.54783/ijsoc.v7i2.1459

Keywords: Chemotherapy, Inguinal Lymph Node Dissection, Paratesticular Rhabdomyosarcoma, Pediatric Oncology.

Abstract

Paratesticular rhabdomyosarcoma (PT-RMS) is a rare, aggressive soft tissue malignancy affecting children and adolescents. Early diagnosis and multimodal treatment are crucial to reduce recurrence and improve survival. We report a 6-year-4-month-old male with advanced PT-RMS presenting with a bleeding scrotal mass, severe malnutrition, and anemia. The patient had previously received 25 chemotherapy cycles and experienced relapse, requiring reinitiation of chemotherapy with vincristine, actinomycin C, and cyclophosphamide. Imaging revealed an extensive fixed mass involving the scrotum, penis, bladder wall, and enlarged inguinal and para-iliac lymph nodes. Multidisciplinary management included supportive care, wide excision, and planned bilateral inguinal lymph node dissection. This case highlights the diagnostic and therapeutic challenges of advanced PT-RMS, emphasizing the role of proper imaging, radical surgery with inguinal lymphadenectomy, and adjuvant chemotherapy to optimize local control and prevent metastasis. Effective management of pediatric PT-RMS requires timely diagnosis, complete surgical resection with lymph node evaluation, and adequate adjuvant therapy to improve outcomes and minimize recurrence risk.

References

Amer, K. M., Thomson, J. E., Congiusta, D., Dobitsch, A., Chaudhry, A., Li, M., ... & Beebe, K. S. (2019). Epidemiology, incidence, and survival of rhabdomyosarcoma subtypes: SEER and ICES database analysis. Journal of Orthopaedic Research®, 37(10), 2226-2230.

Aydın, C., Akkoç, A., Çetin, A., & Aydın, Z. B. (2020). A case of pediatric paratesticular rhabdomyosarcoma misdiagnosed as epididymitis. Bull Urooncol, 19(2), 92-95.

Azizi, M., Babakhouya, A., Rkain, M., & Benajiba, N. (2021). Case Report: The Paratesticular Rhabdomyosarcoma in Children. Journal of Cancer Therapy, 12(6), 358-364.

Bouchikhi, A. A., Mellas, S., Tazi, M. F., Lahlaidi, K., Kharbach, Y., Benhayoune, K., ... & Farih, M. H. (2013). Embryonic paratesticular rhabdomyosarcoma: a case report. Journal of Medical Case Reports, 7, 1-3.

Chalouati, T., Ghalleb, M., Jallali, A., Slimane, M., Sahraoui, G., Ben hassouna, J., ... & Rahal, K. (2022). Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report. Journal of Medical Case Reports, 16(1), 476.

Graiouid, E. M., Chakir, Y., Gallouo, M., Dakir, M., Debbagh, A., & Aboutaieb, R. (2019). Rhabdomyosarcome paratesticulaire: à propos d’un cas. Pan African Medical Journal, 33(1).

Hammond, W. J., Farber, B. A., Price, A. P., Wolden, S. L., Heaton, T. E., Wexler, L. H., & La Quaglia, M. P. (2017). Paratesticular rhabdomyosarcoma: Importance of initial therapy. Journal of pediatric surgery, 52(2), 304-308.

Ihssan, E., Salma, E., Ayoub, M., Amine, S., Zakia, B., & Kaoutar, Z. (2022). Primary intra-testicular rhabdomyosarcoma: case report. International Journal of Surgery Case Reports, 96, 107340.

Kaseb, H., Kuhn, J., Gasalberti, D. P., & Babiker, H. M. (2025). Rhabdomyosarcoma, in: StatPearls (2024). StatPearls Publishing.

Kura, M. M., Umar, A. M., Arogundade, A. K., Afolayan, A. O., Abdulsalam, K. I., & Lawan, A. I. (2025). Giant primary paratesticular rhabdomyosarcoma: a case report and review of surgical and oncologic management. African Journal of Urology, 31(1), 24.

Li, H., Sisoudiya, S. D., Martin-Giacalone, B. A., Khayat, M. M., Dugan-Perez, S., Marquez-Do, D. A., ... & Lupo, P. J. (2021). Germline cancer predisposition variants in pediatric rhabdomyosarcoma: a report from the Children’s Oncology Group. JNCI: Journal of the National Cancer Institute, 113(7), 875-883.

Mejía-Salas, J. A., Sánchez-Corona, H., Priego-Nino, A., Cárdenas-Rodríguez, E., & Sánchez-Galindo, J. A. (2017). Primary testicular rhabdomyosarcoma: a case report. Cirugía y Cirujanos (English Edition), 85(2), 143-147.

Nhungo, C. J., Mtafu, N. H., Mhaya, J. K., Mushi, F. A., Mtaturu, G., Ngaiza, A. I., ... & Mkony, C. A. (2024). Surgical management of huge paratesticular rhabdomyosarcoma in a 20‐year‐old male: Case report and literature review. Clinical Case Reports, 12(8), e9260.

Reniarti, L., Fatharani, N., & Suryawan, N. (2020). Clinical Characteristics of Rhabdomyosarcoma in Children: A 4-Year Study in a Tertiary Hospital. Althea Medical Journal, 7(3), 136-141.

Rogers, T. N., De Corti, F., Burrieza, G. G., Guérin, F., Terwisscha van Scheltinga, S., Smeulders, N., ... & Martelli, H. (2020). Paratesticular rhabdomyosarcoma—Impact of locoregional approach on patient outcome: A report from the European paediatric soft tissue sarcoma Study Group (EpSSG). Pediatric Blood & Cancer, 67(9), e28479.

Rogers, T. N., Seitz, G., Fuchs, J., Martelli, H., Dasgupta, R., Routh, J. C., ... & Rodeberg, D. A. (2021). Surgical management of paratesticular rhabdomyosarcoma: A consensus opinion from the Children's Oncology Group, European paediatric soft tissue sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe. Pediatric blood & cancer, 68(4), e28938.

Routh, J. C., Dasgupta, R., Chi, Y. Y., Shnorhavorian, M., Tian, J., Walterhouse, D. O., ... & Rodeberg, D. A. (2020). Impact of local control and surgical lymph node evaluation in localized paratesticular rhabdomyosarcoma: a report from the Children's Oncology Group Soft Tissue Sarcoma Committee. International journal of cancer, 147(11), 3168-3176.

Sabbagh, A., Hamza, A., Sukkari, M. W., Fattal, A., Chammout, A., Ayoub, K., & Al-Hadid, I. (2023). Paratesticular rhabdomyosarcoma: a rare case report from Syria. Annals of Medicine and Surgery, 85(5), 1928-1931.

Secil, M., Bertolotto, M., Rocher, L., Pekindil, G., Stocca, T., Richenberg, J., ... & European Society of Urogenital Radiology Scrotal Imaging Subcommittee. (2017). Imaging features of paratesticular masses. Journal of Ultrasound in Medicine, 36(7), 1487-1509.

Walterhouse, D. O., Barkauskas, D. A., Hall, D., Ferrari, A., De Salvo, G. L., Koscielniak, E., ... & Minard-Colin, V. (2018). Demographic and treatment variables influencing outcome for localized paratesticular rhabdomyosarcoma: results from a pooled analysis of North American and European cooperative groups. Journal of Clinical Oncology, 36(35), 3466-3476.

Yi, J., Zhou, D. A., Huo, J. R., Wang, Y. H., & Ma, J. A. (2016). Primary intratesticular rhabdomyosarcoma: A case report and literature review. Oncology letters, 11(2), 1016-1020.

Zhu, Y., Zhu, Z., Xiao, Y., & Zhu, Z. (2021). Case report: paratesticular rhabdomyosarcoma. Frontiers in Oncology, 11, 629878.