Paratesticular Rhabdomyosarcoma in Young Adults: A Case Series and Literature Review

Abstract

Background: Paratesticular rhabdomyosarcoma is a rare malignant mesenchymal tumour that mainly affects children and adolescents but may also occur in young adults. Its non-specific presentation as a painless scrotal mass can delay diagnosis and complicate local and regional staging. Aims: To describe the clinical presentation, diagnostic work-up, and therapeutic management of paratesticular rhabdomyosarcoma by presenting three cases and to review current diagnostic and therapeutic strategies for this rare tumour. Presentation of Case: We report three young male patients (aged 19–20 years) who presented with painless, progressively enlarging scrotal masses. Ultrasound and pelvic MRI demonstrated heterogeneous intrascrotal masses that displaced or infiltrated adjacent structures; tumour marker levels were normal in all three cases. Histopathological examination following biopsy or orchiectomy confirmed embryonal paratesticular rhabdomyosarcoma in each patient. Management combined surgery (inguinal orchiectomy or tumour excision) with chemotherapy and, in two cases, retroperitoneal (lumbo-aortic) lymph node dissection. Discussion: Paratesticular rhabdomyosarcoma is a rare, aggressive mesenchymal tumour that typically presents as painless scrotal swelling in children and young adults. Diagnosis relies on imaging for local and locoregional staging and on histopathological confirmation, as no specific serum tumour marker exists. Management is multimodal and combines surgery, chemotherapy, and selective radiotherapy. Conclusion: Early clinical and radiological recognition, an accurate extension work-up, and a well-defined multimodal treatment strategy are essential for improving the prognosis of this rare malignancy.