Paratesticular rhabdomyosarcoma in a low-resource setting: a case report of an aggressive disease amidst systemic healthcare limitations

Abstract Background Paratesticular rhabdomyosarcoma is an uncommon tumor, particularly in adults. While most cases of embryonal variant are diagnosed in children, adult presentation is sporadic and carries a worse prognosis. We present a case of a young adult with an unusually aggressive embryonal paratesticular rhabdomyosarcoma who experienced early relapse despite radical orchidectomy and adjuvant chemotherapy. Case presentation A 19-year-old male who previously underwent right radical orchidectomy for an ulcerated giant right scrotal mass, pathologically confirmed as paratesticular embryonal rhabdomyosarcoma (positive for desmin). Despite receiving adjuvant chemotherapy with vincristine, actinomycin-D, and cyclophosphamide (VAC), 4 months post-orchidectomy, he presented with a one-month history of a rapidly growing, painless right inguinoscrotal mass. He was systemically well but had a right inguinoscrotal swelling, which was soft to firm in consistency. Scrotal and abdominopelvic ultrasound scans showed a large complex right scrotal mass extending into the inguinal and pelvic areas with no obvious ascites or enlarged paraaortic nodes. He underwent tumor debulking surgery, with intraoperative findings of an inguinoscrotal mass extending into the pelvis with solid and cystic components. The cystic component contained hemorrhagic and gelatinous collections. Postoperative management involving second-line chemotherapy and radiotherapy was planned, but the patient was subsequently lost to follow-up. Conclusion Adult paratesticular rhabdomyosarcoma constitutes a therapeutic challenge with high recurrence rates and poor survival. Our case report demonstrated the aggressive nature of adult rhabdomyosarcoma and the limitations of pediatric-derived chemotherapy protocols in managing adult patients. This underscores the need for standardized adult-specific regimens and molecular profiling to improve patient outcomes and survival.