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Spindle cell/sclerosing rhabdomyosarcoma of the testicle

Case contributed by Ryan Thibodeau
Diagnosis certain

Presentation

On physical exam, a scrotal mass was palpated, which appeared to arise primarily from the left hemiscrotum.

Patient Data

Age: 15 years
Gender: Male

Within the left hemiscrotum, there is a hypoechoic paratesticular mass adjacent to the left testicle that demonstrates flow on color Doppler.

There is hydrocele within the left hemiscrotum.

Case Discussion

This is a mixed spindle cell/sclerosing (70%) and conventional (~30) rhabdomyosarcoma. The patient underwent a left radical orchiectomy with retroperitoneal lymph node dissection.

Pathologic specimens from the left orchiectomy showed a malignant neoplasm with varied histomorphology. There were tumor foci of hypercellular and hypocellular sheets of primitive, round cells with high nuclear-to-cytoplasmic ratio. Occasional myxoid stroma was seen. There was storiform architecture with ovoid to spindled cells embedded in a collagenous stroma. Rhabdomyoblasts and strap cells were seen within both components. The tumor extensively involved paratesticular soft tissue and infiltrated into the epididymis and spermatic cord. The tumor did not involve the testis parenchyma but did focally involve the soft tissue margin and the spermatic cord margin. Lymphovascular invasion was present. No necrosis or perineural invasion was identified. Immunohistochemical showed diffuse and strong nuclear staining for myogenin and focal cytoplasmic staining for desmin.

Co-authors:
Samantha Scott
Travis Bevington, MD

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