Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report
Abstract Introduction Paratesticular 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, ch...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03707-x |
| _version_ | 1797977418627022848 |
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| author | Takoua Chalouati Montassar Ghalleb Amani Jallali Maher Slimane Ghada Sahraoui Jamal Ben hassouna Riadh Chargui Khaled Rahal |
| author_facet | Takoua Chalouati Montassar Ghalleb Amani Jallali Maher Slimane Ghada Sahraoui Jamal Ben hassouna Riadh Chargui Khaled Rahal |
| author_sort | Takoua Chalouati |
| collection | DOAJ |
| description | Abstract Introduction Paratesticular 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 report We 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. Conclusion Rhabdomyosarcoma 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. |
| first_indexed | 2024-04-11T05:06:37Z |
| format | Article |
| id | doaj.art-9349f233c44c428c82a347c4af7924ed |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-11T05:06:37Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-9349f233c44c428c82a347c4af7924ed2022-12-25T12:17:38ZengBMCJournal of Medical Case Reports1752-19472022-12-011611610.1186/s13256-022-03707-xSurgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case reportTakoua Chalouati0Montassar Ghalleb1Amani Jallali2Maher Slimane3Ghada Sahraoui4Jamal Ben hassouna5Riadh Chargui6Khaled Rahal7Surgical Oncology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologyHistology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologySurgical Oncology Department, Salah Azaiez Institute of OncologyAbstract Introduction Paratesticular 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 report We 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. Conclusion Rhabdomyosarcoma 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.https://doi.org/10.1186/s13256-022-03707-xParatesticular rhabdomyosarcomaParaaortic lymph nodesSurgery |
| spellingShingle | Takoua Chalouati Montassar Ghalleb Amani Jallali Maher Slimane Ghada Sahraoui Jamal Ben hassouna Riadh Chargui Khaled Rahal Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report Journal of Medical Case Reports Paratesticular rhabdomyosarcoma Paraaortic lymph nodes Surgery |
| title | Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report |
| title_full | Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report |
| title_fullStr | Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report |
| title_full_unstemmed | Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report |
| title_short | Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report |
| title_sort | surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma a case report |
| topic | Paratesticular rhabdomyosarcoma Paraaortic lymph nodes Surgery |
| url | https://doi.org/10.1186/s13256-022-03707-x |
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