PMC10282740_01
CT examination. (A) The CT scan before the surgery shows a mixed-density mass in the right scrotum, watery density (red arrow), and fat density (blue arrow) in the mass. (B) Enhanced CT before the surgery shows uneven reinforcement. (C) The CT scan after the surgery. (D) Enhanced CT after the surgery; the mass was completely removed.
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Pelvic CT revealed a mixed-density mass in the right scrotum with a maximum cross-sectional area of approximately 76.5 mm x 64.5 mm and watery density and fat density in the mass, and enhanced scanning showed uneven reinforcement ( Figures 1A, B ). Figures 1C, D ). For better treatment, right radical inguinal orchiectomy (RIO) with right scrotal resection was further performed.
Para-testicular mass after first excision. (A) The smooth appearance of the para-testicular SRMS; the size was approximately 6 cm x 7 cm x 4 cm, and its envelope is intact. (B) The cut surface of the tumor. It mainly consisted of two parts: grayish-yellow tissue and fish-flesh appearance tissue. The central part of the tumor was mainly grayish-yellow tissue (blue *) with mild liquefaction (red *) visible, and the surrounding part was mainly grayish-white, fine-textured fish-flesh appearance tissue (purple *), and the two parts are growing in a fused pattern with no clear demarcation.
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The central part of the tumor was mainly grayish-yellow tissue with mild liquefaction visible, and the surrounding part was mainly grayish-white, fine-textured fish-flesh appearance tissue ( Figures 2A, B ).
Pathological features of para-testicular SRMS. (A) Histopathological section (hematoxylin and eosin staining), x200. (B) Immunohistochemistry results showing the expression of MyoD1 (+), x200. (C) Immunohistochemistry results showing the expression of desmin (+), x200. (D) Immunohistochemistry results showing the expression of S-100 (-), x200. (E) Immunohistochemistry results showing the expression of myogenin (-), x200. (F) Immunohistochemistry results showing the expression of CD34 (-), x200. SSRMS, spindle cell/sclerosing rhabdomyosarcoma.
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Immunohistochemically, the results were as follows: myogenin (-), MyoD1 (+), desmin (+), CD34 (-), S-100 (-), Ki-67 (30%+), CD99 (-), MDM2 (+), SMA (Vessel+), and BCoR (-) ( Figures 3A-F ), but the fluorescence in situ hybridization (FISH) test of MDM2 gene is negative.