Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2641-2646
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2641
Pleomorphic rhabdomyosarcoma of the spermatic cord and a secondary hydrocele testis: A case report
Xin Chen, Ci Zou, Chao Yang, Liang Gao, Liang-Kuan Bi, Dong-Dong Xie, De-Xin Yu
Xin Chen, Ci Zou, Chao Yang, Liang-Kuan Bi, Dong-Dong Xie, De-Xin Yu, Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
Liang Gao, Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
Author contributions: Chen X, Zou C, Yang C, and Yu DX performed the surgery; Gao L, Bi LK, and Xie DD completed the figure illustration; all authors contributed to writing and revising this report; Chen X is the main author and Yu DX is the senior author; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: De-Xin Yu, MD, Chief Doctor, Surgeon, Department of Urology, The Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei 230032, Anhui Province, China. yudx_urology@126.com
Received: March 9, 2020
Peer-review started: March 9, 2020
First decision: April 22, 2020
Revised: May 26, 2020
Accepted: May 28, 2020
Article in press: May 28, 2020
Published online: June 26, 2020
Processing time: 106 Days and 14.5 Hours
Abstract
BACKGROUND

Pleomorphic rhabdomyosarcoma (RMS) of the spermatic cord is a group of rare neoplasms, and a secondary hydrocele testis occasionally occurs. The misdiagnosis of paratesticular mass may lead to a therapeutic delay.

CASE SUMMARY

A 79-year-old man presented to our clinic complaining of a 1-mo history of painless scrotal swelling. Physical examination revealed approximately a 15 cm × 10 cm × 5 cm inguinal mass with limited mobility. Contrast-enhanced magnetic resonance imaging showed a hydrocele testis, several enlarged inguinal lymph nodes, and a heterogeneously enhanced lesion with a relatively well-defined margin in the left inguinal region. Due to the imaging findings, he was diagnosed with pleomorphic RMS and received a wide resection of the mass, an inguinal incision with a high section of the left spermatic cord, and a left radical orchiectomy. He experienced local relapse 1 mo postoperatively and received radiotherapy and anlotinib hydrochloride-based immunotherapy as adjuvant therapy. The patient died 3 mo after the surgery.

CONCLUSION

The optimal interventions for advanced-stage pleomorphic RMS patients should be investigated by more preclinical studies and clinical trials. Physicians need to be aware of the occurrence of pleomorphic RMS in unusual locations, especially when accompanied by a hydrocele testis.

Keywords: Pleomorphic rhabdomyosarcoma; Spermatic cord; Secondary hydrocele testis; Case report

Core tip: Pleomorphic rhabdomyosarcoma of the spermatic cord is rare and develops commonly in adults, which is still clinically challenging for definitive diagnosis and differentiation from other pathologies, especially when accompanied by a secondary hydrocele testis. The present case report as well as state-of-the-art literature review highlights the importance of comprehensive appreciation of laboratory, radiographic, and pathologic findings for the ultimate differential diagnosis of spermatic cord rhabdomyosarcoma.