Painless Scrotal Swelling Research Articles

Spermatic cord liposarcoma presented as scrotal swelling: a case report

BackgroundLiposarcoma is considered the most common among spermatic cord sarcomas. It usually presents as a progressively enlarging inguinoscrotal mass. The resemblance between the spermatic cord liposarcoma and the inguinal hernia allows the swelling to be tolerated for a long duration giving time for hematogenous dissemination. In this article, we share the experience of a unique case of metastatic liposarcoma of the spermatic cord that showed a stationary course of the lower abdominal satellite lesions on follow-up following palliative resection.Case presentationWe present a case of a 53-year-old male with progressively enlarging painless scrotal swelling over 1-year duration. A heterogeneous lesion of the right hemiscrotum and spermatic cord with non-specific radiological features was described by imaging. Two lower abdominal skip lesions were also discovered synchronously in addition to the primary one and were designated inoperable as they were adherent to the nearby bowel loops. The patient underwent cytoreductive surgery of the primary tumour which was proven to be an undifferentiated liposarcoma with free safety margins based on histopathology. Finally, the patient was referred for adjuvant chemotherapy and sequential follow-up.ConclusionsDespite being a rare tumour, the radiologist should always consider the liposarcoma of the spermatic cord in the differential diagnosis of inguinoscrotal lesions even in the absence of typical imaging features. The diagnosis and management of spermatic cord liposarcoma remain a challenge with no clear accepted guidelines.

Exploring Scrotal Leiomyomas, Unraveling the Mysteries of a Rare Tumor: A Case Report

Leiomyomas, originating from smooth muscle cells, are common in the uterus but rare in the scrotum, presenting a clinical challenge. Scrotal leiomyomas, first described in the 19th century, are characterized by benign pathology from the subcutaneous dartos muscle. We present two cases of middle-aged males with scrotal leiomyomas, detailing clinical presentations, histopathological findings, and immunohistochemistry results. The first involved a 48-year-old with a painless scrotal lump, excised to reveal well-circumscribed smooth muscle bundles. Immunohistochemistry confirmed vimentin, desmin, and smooth muscle actin (SMA) positivity, consistent with scrotal leiomyoma. The second case featured a 25-year-old with a painless scrotal swelling, histologically matching the features of scrotal leiomyoma. Accurate diagnosis is crucial for guiding appropriate management strategies. Clinicians often employ a combination of clinical evaluation, imaging studies, and histopathological examination to confirm the presence of scrotal leiomyomas. Ultrasound remains a valuable tool for assessing the size, location, and vascularity of the tumor, aiding in the formulation of a differential diagnosis. Definitive diagnosis, however, relies on histological examination, which typically reveals spindle-shaped smooth muscle cells arranged in interlacing bundles.

Testicular leukaemic infiltration in relapsed acute lymphoblastic leukaemia: a case report

Abstract Background Although paediatric patients with acute lymphoblastic leukaemia (ALL) have improved survival following modern chemotherapy treatment, disease relapses still occur in 20–25% of them. Our case had relapsed ALL with testicular leukaemic infiltration, which is rare, with less than 2% incidence. Case presentation We describe a case of an 11-year-old boy with a background history of ALL presenting with painless unilateral scrotal swelling. An initial ultrasound of the testes showed heterogeneity throughout with hypervascularity on colour-flow imaging on the affected testis. Some areas are hypoechoic with dilated tubules. The histopathology of the follow-up testicular biopsy revealed malignant cells and leukaemic infiltration. Patient subsequently received chemotherapy treatment at another centre. Conclusions Testicular relapse of ALL is relatively rare with the use of improved contemporary frontline treatment with better outcomes. With its non-specific symptoms, radiological imaging can significantly facilitate timely diagnosis and contribute to appropriate further management and improved prognosis.

Largest testicular tumour in South-East Asia: a case report

We present the largest testicular tumour that first ever reported in Malaysia and we believed first reported in Southeast Asia. A 21 years old Malay gentleman presented to us with painless large scrotal swelling. After the initial workup and investigations were done and followed by a CT scan which yield a multiple paraaortic lymph nodes, the patient was scheduled listed in the earliest list for high ligation right orchidectomy with an inguinal approach. The patient seeks treatment at that point because he can't bear the embarrassment and fear of the treatment.

A Rare Case Report of an Extra Pulmonary Tuberculosis: Testicular Tuberculosis

Testicular tuberculosis (TB) is a rare form of genitourinary TB. It presents as a painless or slightly painful scrotal swelling and so it is difficult to differentiate from typical epididymo-orchitis or other conditions such as tumor or infraction. Middle aged males, especially of 20–40 years of age are most commonly affected, and presented with painful or painless scrotal swelling with or without discharging sinus. Epididymal involvement is usually seen in testicular TB. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling for the diagnosis was done, CBNAAT of aspirated fluid of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, surgical removal is required for both diagnosis and treatment. Here, we report a very rare case of left sided isolated testicular TB in a 60-year-old male who was completely cured with 6 months regimen of anti-TB chemotherapy.

Young Boy With Scrotal Swelling

A healthy 4-year-old boy presented to the emergency department for sudden onset of painless scrotal redness and swelling. There was no trauma, fever, or dysuria. On examination, he had generalized scrotal swelling with thickened, warm, and erythematous scrotal skin and with absence of scrotal pain on palpation (Figure 1). The emergency physician performed a bedside ultrasound showing edematous thickening, easy compressibility of the scrotal wall, and diffuse hypervascular paratesticular scrotal soft tissues on color Doppler images (Figure 2).

Rare case cystic scrotal lymphangioma presented as a hydrocele.

Introduction and importanceCystic scrotal lymphangiomas are very uncommon lesions caused by congenital lymphatic malformation. These tumors are usually located in the neck and axilla, occasionally in the mediastinum, retroperitoneum, and thigh. The scrotum and perineum are the least frequented sites. They present as painless scrotal swelling and are easily misdiagnosed as hydrocele. We present here a case of cystic scrotal lymphangioma in a school-aged child who presented to us with a massive scrotal swelling.Case presentationWe present here a case of a 6-year-old child who presented with scrotal swelling, which was sonographically identified as chronic hydrocele. The right testis could be felt separately from the mass, and the left scrotum was normal. Scrotal ultrasound reveals multiple cystic lesions with septa in the right hemiscrotum extending to the proximal inguinal canal. Median raphe incision and excision of the lobulated mass Cyst testicular lymphangioma was confirmed histopathologically.Clinical discussionCystic lymphangiomas are benign congenital tumors with no identifiable cause. The majority of lymphangiomas (90%) appear during the first two years of life, and half of them are present at birth. Lymphangiomas are categorized into three types: capillary, cavernous lymphangiomas, and cystic hygromas. A scrotal lymphangioma is frequently misdiagnosed as a hydrocele, inguinal hernia, hematocele, varicocele, or even testis torsion. In our case, the diagnosis was made by ultrasonography with Doppler and confirmed by a biopsy of an excised mass lesion. The scrotum is a very uncommon site for cystic lymphangioma.ConclusionA cystic or septate cystic mass discovered intra-operatively should not be dismissed as a complex hydrocele, since cystic lymphangiomas predictably recur if incompletely resected. A proper diagnosis of the scrotal lymphangioma and its extent using the US is essential for planning an appropriate surgical approach.

Malignant Mixed Germ Cell Tumor of the Testis with Associated Nephroblastoma: A Rare Entity

Abstract Introduction/Objective While nephroblastoma is the most common primary childhood renal malignancy, it rarely occurs at extra-renal sites. Testicular nephroblastoma is exceedingly rare, with only 5 previously reported cases arising in association with primary testicular teratoma (4 of which arising in non-atrophic, and 1 arising in atrophic testis). We report a case of testicular nephroblastoma with multiple associated germ cell components. Methods/Case Report The case is that of a 28-year-old male presenting with an enlarging, painless right scrotal swelling. Laboratory results showed elevated serum AFP with normal LDH and beta-HCG, and imaging confirmed the presence of a heterogenous testicular mass. A radical orchiectomy was performed, revealing a tan-white, fleshy, nodular 5.5 cm mass almost entirely replacing the testicular parenchyma. Microscopically, the tumor consisted of multiple components. The nephroblastoma component was associated with teratoma with immature elements and consisted of epithelial tubular structures, small blue blastemal cells, and pale mesenchymal stroma which demonstrated pan-cytokeratin and patchy WT1 expression by immunohistochemistry. Additional components included yolk sac tumor and minor component of seminoma. Foci of germ cell neoplasia in-situ were also identified, supported by immunohistochemical stains for PLAP and OCT3/4. The patient’s post-resection tumor markers normalized, and further assessment for metastasis and chemotherapy is pending. Results (if a Case Study enter NA) NA Conclusion Malignant mixed germ cell tumors of the testis with associated nephroblastoma are exceedingly rare, further studies nand followup are required to determine prognostic values and achieve a more complete understanding of this combination of entities.

Isolated tuberculous epididymal mass mimicking testicular malignancy: an interesting case report and lessons learnt

Tuberculous epididymal mass is a condition that presents as a painless scrotal swelling. It resembles a testicular mass and is more often diagnosed after orchidectomy. About 22% of all genitourinary tuberculosis show epididymal involvement and 22% of epididymal tuberculosis are bilateral. This report reiterates the need for an increased awareness amongst the treating urologists that would enable an earlier diagnosis, appropriate treatment and may avert the need for orchidectomy in most cases. A 35-year-old diabetic male presented with rapidly enlarging right testicle associated with recent onset of pain over the testis. He also had fever and chills. At the age of 18, he was treated for pulmonary tuberculosis. The right testicle was enlarged, irregular and mildly tender. The right epididymis was also irregular and nodular, blended with the right testicle and indistinguishable from it. A clinical diagnosis of testicular tumour was made. Tumour markers were normal and he underwent high orchidectomy. Histopathological diagnosis confirmed right epididymal tuberculosis. This case report mainly highlights the need for a high index of suspicion amongst the treating physicians. A previous history of treatment for pulmonary tuberculosis should alert the physician to think in lines of tuberculous pathology in epididymis too. A prompt diagnosis and early, appropriate treatment would largely prevent removal of testicles in most cases.

S2126 Metastatic Testicular Embryonal Carcinoma Presenting as Gastrointestinal Hemorrhage

INTRODUCTION: Metastatic testicular embryonal carcinoma presenting as gastrointestinal hemorrhage is an uncommon phenomenon. While testicular cancer is the most common malignancy in males 20–35 years of age, metastases to the gastrointestinal tract occur at an incidence of less than 5%. In a young man with otherwise unexplained gastrointestinal hemorrhage, it is important to consider the possibility of underlying malignancy. CASE DESCRIPTION/METHODS: A previously healthy 27-year-old male presented with two weeks of abdominal pain and three days of melena and hematemesis. He was found to be in hemorrhagic shock with a hemoglobin of 5.3 and resuscitated aggressively with blood products and fluids. A CT abdomen/pelvis showed a large 15.1 cm × 13.9 cm × 8.6 cm hypervascular soft tissue mass with a necrotic center and multiple foci of contrast blush located adjacent to the third portion of the duodenum, extensive peritoneal and retroperitoneal lymphadenopathy, and multiple lung masses (Figure 1). Esophagogastroduodenoscopy (EGD) revealed an exophytic mass-like obstruction in the duodenum that when traversed, revealed a large cavity filled with necrotic tissue and old blood extending from the third portion of the duodenum deep into the subperitoneal space (Figure 2) with slow hemorrhage from friable tissue treated with coagulation graspers. The patient's clinical course was complicated by multiple episodes of recurrent hemorrhage requiring repeat endoscopic treatment with bipolar coagulation, epinephrine injection, and hemostatic powder application. A diagnosis of germ cell tumor was made based on scrotal US showing multiple masses and a significantly elevated beta-HCG. He was treated with chemotherapy with subsequent decrease in the size of his abdominal mass and resolution of bleeding. DISCUSSION: Testicular cancer is the most common malignancy in males 20–35 years of age, usually presenting with painless scrotal swelling. Metastases can involve retroperitoneal lymph nodes, which drain the testes. Gastrointestinal metastases are rare, and metastatic disease may not initially be considered in a young male presenting with gastrointestinal hemorrhage. This case demonstrates the importance of testicular imaging and exam should there be concern for underlying malignancy, especially if other causes of gastrointestinal hemorrhage have been ruled out. Early diagnosis and intervention may often lead to improved clinical outcomes.Figure 1.: CT abdomen showing a large heterogeneously enhancing hypervascular soft tissue mass which appears to be contiguous with the third part of the duodenum. Large necrotic central component present.Figure 2.: EGD showing duodenal lumen immediately proximal to the cavity. Note the adherent clot at the top of the abnormal tissue directly in front.Figure 3.: Necrotic cavity in duodenum.

Hydrocelectomy through Inguinal Approach in Adults

Background: hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is approximately 1%, although prevalence varies according to country. Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral (idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy. Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67), whereas the patients included in the scrotal approach group had an age range of 16–48 years (mean 29.35±8.93). The difference in mean age between the two groups was statistically insignificant. The mean volume of the hydrocele sac was 196± 30.28 ml (range, 155–250 ml) in the inguinal approach group and 197.75±26.72 ml (range, 150–260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups was statistically not significant. Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows management of any associated lesions in the inguinal canal.

Hydrocelectomy through Inguinal Approach in Adults

Background: hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is approximately 1%, although prevalence varies according to country. Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral (idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy. Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67), whereas the patients included in the scrotal approach group had an age range of 16–48 years (mean 29.35±8.93). The difference in mean age between the two groups was statistically insignificant. The mean volume of the hydrocele sac was 196± 30.28 ml (range, 155–250 ml) in the inguinal approach group and 197.75±26.72 ml (range, 150–260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups was statistically not significant. Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows management of any associated lesions in the inguinal canal.

Scrotal migration of a ventriculoperitoneal shunt

We report a case of scrotal migration of a ventriculoperitoneal (VP) shunt that presented as a hydrocele in an 18‐month‐old boy. The patient had a history of congenital hydrocephalus secondary to aqueductal stenosis requiring VP shunting at 1 month of age. He subsequently presented with painless progressive right scrotal swelling for 12 months with the distal segment of the shunt's peritoneal catheter palpable within the scrotum, which was confirmed by X‐ray imaging. Groin exploration for catheter removal and high ligation of the hydrocele were performed. Postoperatively, there was no recurrence of the hydrocele. We recommend that all infant patients with an implanted VP shunt undergo regular scrotal examinations at the neurosurgical clinic, and that early surgical intervention should be considered when a hydrocele is detected.

Testicular Cancer at the University of Port Harcourt Teaching Hospital: A 10-year Retrospective Review.

Background:Testicular cancers are rare malignancies. They are however very common in males aged 15–40 years. Reports of increasing incidence of testicular cancer in western countries have been noted. Despite the increasing incidence, mortality has remained low in these countries. There are few publications on the management of testicular tumors in Nigeria.Aim:The aim of this study was to determine the hospital prevalence and highlight our experience in the management of patients with testicular cancer.Materials and Methods:This was a 10-year retrospective study on patients diagnosed with histologically confirmed testicular cancer from January 2009 to December 2018. The case records were retrieved. Data obtained included biodata, clinical presentation, investigations, treatment received and outcomes. Data analysis was carried out using SPSS version 20.0.Results:Eleven patients with testicular cancer were managed during the study period, constituting 0.01% of new cases seen in the hospital. Peak age was 20–29 years (54.55%), with a mean age of 29.27 ± 9.51yrs. The most common presentation was painless scrotal swelling, observed in nine (81.8%) patients. Nine (81.8%) patients presented six months or more after onset of symptoms with advanced disease. Distant metastasis was seen in two (18.2%) patients. Right sided disease was found in seven (63.6%) and left sided disease in four (36.4%). All had radical inguinal orchidectomy. The most common histological diagnosis was seminoma in 8 (72.7%) patients. All the subjects were offered four courses of chemotherapy with bleomycin, etoposide and cisplatin. However, only four (36.4%) completed the chemotherapy. A statistically significant association was observed between the duration of symptoms and the disease stage (P = 0.003), and between number of chemotherapy sessions and survival (P = 0.02).Conclusion:Testicular cancer was an uncommon condition in the catchment area of the University of Port Harcourt Teaching Hospital, affecting relatively young men. The commonest presenting complaint was painless scrotal swelling. Most patients presented with Stage II disease, with seminoma being the commonest histopathology. All had surgical treatment; adjuvant chemotherapy improved 5-year survival. Public education is necessary to surmount sociocultural barriers to effective management of testicular tumors in our environment.

Prepubertal testicular tumors in China: a 10-year experience with 67 cases.

Prepubertal testicular tumors are rare in children. We aim to present clinical and histological features of prepubertal testicular tumors through the analysis of the long-term experiences of a single medical center of China. A total of 67 children (≤ 14years) treated for testicular tumor at our institution from 2005 to 2015 were retrospectively reviewed. Data relating the clinical characteristics, histopathology findings, serum tumor markers, treatment method, and outcome were collected. The patients' median age at diagnosis was 18months (range 3-168months), and 49 cases (73.1%) were diagnosed at age younger than 3years. The most common clinical presentation was a painless scrotal mass or swelling. Regarding histology, 32 (47.8%) were teratomas and only one of these tumors presents immature teratomas, 20 (29.9%) were yolk sac tumors, 9 (13.4%) were epidermoid cyst, 1 (1.5%) was a Leydig cell tumor, 1 (1.5%) was a mixed malignant germ cell tumor, and 4 (8.3%) were paratesticular tumors. For germ cell tumors, the mean preoperative serum α-fetoprotein (AFP) level was significantly higher in patients with yolk sac tumor than in those with teratomas (2,078ng/mL vs 5.7ng/mL). Of all these patients, 37 (55.2%) were treated with radical inguinal orchiectomy and testis-sparing surgery was planned and achieved in 30 (44.8%). Surveillance was performed in 60 patients. None of the patients developed recurrence or testicular atrophy after appropriate treatment. The majority of our cases were benign, with the most common histopathological subtype being teratoma. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumor markers. This study shows a better outlook for prepuberty patient with testicular tumors than their adult counterparts.

Malignant Mesothelioma of the Tunica Vaginalis: Incidental Diagnosis of a Rare Condition

Mesothelioma is a malignant tumor that involves mesothelial cells that normally line the body cavities, including the pleura, peritoneum, pericardium, and testis. Testicular mesothelioma (TM) is a rare type of mesothelioma that affects tunica vaginalis, tunica albuginea, spermatic cord, and the epididymis. The frequency of TM is unknown; however, fewer than 100 cases have been reported across the world. A 47-year old male presented with a painless scrotal swelling of 3-month duration with no history of testicular trauma or any inflammatory manifestations. Clinical and sonographic examination revealed right-sided scrotal hydrocele. The patient was scheduled for subtotal excision of the tunica vaginalis. During surgery, the surgeon observed multiple variable-sized suspicious nodules on the visceral surface of the tunica vaginalis. Upon excision of the tunica vaginalis, the specimen was sent for histopathologic examination which concluded the diagnosis of malignant mesothelioma of the tunica vaginalis. Complete metastatic work-up was performed, and no metastatic deposits were identified. The patient then underwent high inguinal orchiectomy which revealed residual mesothelioma in the remaining parts of tunica vaginalis and epididymal area, yet the testis and spermatic cord were free of malignancy. TM, although a rare entity, should be included in the differential diagnosis of scrotal and testicular complaints. Careful assessment of the tunica vaginalis during scrotal and testicular surgery is crucial since TM can be incidentally discovered during surgery. Histopathologic examination of any suspicious lesion in the tunica vaginalis is imperative to exclude malignant mesothelioma.

Comparative study of inguinal versus scrotal approach in idiopathic vaginal hydrocele.

Background: Hydrocele is a common cause of painless scrotal swelling worldwide.Methods: Hydrocele is a common cause of painless scrotal swelling worldwide. This prospective study was carried out at AVBRH, Sawangi Wardha, Maharashtra, India with the aim of comparing scrotal and inguinal approaches of hydrocelectomy. 100 patients were enrolled between September 2015 and September 2017 and were randomly selected for inguinal and scrotal approaches (n=50 each). They were compared on the basis of volume of hydrocele sac, operative time, post-operative hospital stay, post-operative complications, number of doses of injectable analgesia required and time of return to daily life activity.Results: The patients’ age ranged from 23 to 65 years (42.80±9.73 years) in the inguinal approach group and 22 to 65 years (41.30±11.21 years) in the scrotal approach group. Operative time in the scrotal approach group was less and was associated with more post-operative complications (pain and scrotal edema being frequent), longer hospital stay, increased requirement of injectable analgesia dosage. On the other hand, inguinal approach group had a marginally longer operative time and was associated with less post-operative pain, none to minimal complications, less hospital stay and early return to daily life activities. Conclusions: Thus, hydrocelectomy by inguinal approach is an effective alternative method for the treatment of idiopathic hydrocele.

AB157. 189. Pneumoscrotum—a curious presentation of bowel perforation post sigmoidoscopy

: Pneumoscrotum is defined as air within the scrotum and may be of primary or secondary aetiology. Although itself benign, it may however be indicative of significant underlying pathology. We aim to use this case of a presentation of pneumoscrotum to illustrate a case of iatrogenic bowel perforation. We present the case of Mr. SR, a 63-year-old gentleman who presented to the Emergency Department with a 1-day history of painless scrotal swelling. The swelling occurred post flexible sigmoidoscopy the same day, performed to assess the rectal stump for suitability of ileoanal anastomosis post subtotal colectomy for ulcerative colitis. The patient was otherwise stable and pain-free. Examination revealed a grossly swollen scrotum preventing micturition as well as palpable subcutaneous emphysema in the scrotum and peristomal region, in a non-tender abdomen. Subsequent imaging of the abdomen and pelvis confirmed abdominal subcutaneous emphysema and pneumoscrotum. The patient was managed medically with intravenous antibiotics for 3 days and discharged home well. At subsequent outpatient review three months later, the patient was clinically well and is awaiting ileal pouch anal anastomosis. There are many causes of pneumoscrotum ranging from trauma to Fournier’s Gangrene, however, our case illustrates a seemingly benign condition in fact represented an iatrogenic bowel perforation which required inpatient admission and antimicrobial management. Perforation post colonoscopy is itself uncommon and a presentation such as this even less so. Careful history taking and examination is essential and an index of suspicion for life-threatening pathology must be maintained.

290 Rhabdomyosarcomatous Differentiation in a Testicular Germ Cell Tumor Determined by FISH Detection of 12p11.21 Duplication

Testicular germ cell tumors (GCTs) with sarcomatous differentiation are rare. They may have histological features identical to paratesticular sarcomas and hence specific molecular diagnostic markers can be useful to establish a definitive diagnosis. A 34-year-old man presents with painless scrotal swelling of 4 months’ duration with midline back pain. On examination, he had a painless firm mass in the scrotum, and CT showed a large testicular mass, an L5 compression fracture, and a right lung lower lobe nodule. Serologic evaluation revealed elevated LDH (1.54x normal), and normal AFP and HCG. Right radical orchiectomy was performed. The specimen weighed 1,348 g, and the testis was entirely replaced by a fleshy focally hemorrhagic and necrotic mass measuring 14.9 x 13.5 x 12.9 cm. Histologically, the tumor cells were ovoid to spindled with hyperchromatic nuclei and areas of rhabdomyoblastic differentiation exhibiting cross striations. Architecturally, the tumor formed fascicles without any other identifiable growth pattern typical of a mixed germ cell tumor. Immunoperoxidase stains for desmin, Myo-D1, myogenin, and MSA were positive, consistent with a diagnosis of rhabdomyosarcoma, embryonal type. However, the differential diagnosis included both primary rhabdomyosarcoma such as that arising within the paratesticular soft tissue and secondary rhabdomyosarcomatous differentiation of a testicular GCT. Given that sarcomas deriving from GCT often retain signature chromosomal anomalies such as isochromosome 12p, FISH studies were performed. FISH did not detect isochromosome 12p but demonstrated ~99% of tumor cells had duplication of the 12p11.21 region, which is a less common, but reported, abnormality in GCT. The differential diagnosis of intrascrotal sarcoma includes both primary paratesticular sarcomas as well as secondary sarcomatous transformation of testicular GCT. Extensive histological sampling and cytogenetic analysis for signature chromosomal anomalies in testicular germ cell tumors may be helpful in establishing a diagnosis when a non-sarcomatous element is not demonstrated.

Paratesticular rhabdomyosarcoma – Spindle cell variant: Case report of a rare tumor

Testicular and paratesticular rhabdomyosarcomas (RMSs) in children are uncommon tumors. Histologically though embryonal RMS is common, the spindle cell variant is considered rare. Paratesticular RMS presents in children and adolescents with a unilateral, painless scrotal swelling or mass above the testis. We report the case of a 15-year-old boy, with a left paratesticular mass who underwent high inguinal orchidectomy. Histopathological examination of the specimen demonstrated spindle cell RMS (SC-RMS). Because of its morphological resemblance to spindle cell neoplasms such as leiomyosarcomas and fibrosarcomas, SC-RMS may pose diagnostic difficulties for the pathologist. This problem can be overcome by a careful search for rhabdomyoblasts in sections and immunohistochemistry for myogenin. We are reporting this case as paratesticular RMS itself is uncommon, and the spindle cell variant of embryonal RMS is all the more rare. There are lacunae in our knowledge about their presentation, diagnosis, response to treatment, and cure.