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Abstract
A 20-year-old white man presented with a 14-month history of painless enlargement of the left hemiscrotum. Physical examination revealed a normal left testis and a 3 3 6 cm. firm, irregularly shaped nontender mass at the tail of the epididymis. Serum markers for b-human chorionic gonadotropin, a-fetoprotein and lactate dehydrogenase were normal. Scrotal ultrasound showed a 2.5 3 6 cm. vascular, solid mass with no intratesticular component. Computerized tomography of the chest, abdomen and pelvis was normal. Frozen section at inguinal exploration demonstrated adenomatoid tumor and the mass was excised, sparing the epididymis and testicle. Histological examination revealed bundles of spindle cells with eosinophilic and clear cytoplasm, and rhabdomyoblasts with plump eosinophilic cytoplasm (see [fgc]figure). Desmin, myoglobin and myo-D1 immunostains confirmed skeletal muscle differentiation. Permanent sections disputed the frozen section diagnosis and subsequent hisopathological evaluation confirmed spindle cell rhabdomyosarcoma. After consultation with the most current Intergroup Rhabdomyosarcoma Study protocol and extensive discussion with the patient, he elected to undergo left modified nerve sparing retroperitoneal lymph node dissection and inguinal orchiectomy. Pathological evaluation revealed no evidence of tumor metastasis. The patient experienced antegrade ejaculation 2 months postoperatively and there were no complications from surgery. Chemotherapy was initiated. DISCUSSION
Published Version
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