小儿睾丸旁横纹肌肉瘤的临床诊断学特征

The clinical characters of paratesticular rhabdomyosarcoma in children

目的探讨小儿睾丸旁横纹肌肉瘤的临床诊断学特征及治疗。方法回顾性分析佛山市中医院泌尿外科2018年6月4日收治的1例睾丸旁横纹肌肉瘤患儿的临床资料,并进行文献复习。结果患儿临床表现为左侧进行性增大的阴囊肿物,生化、免疫、肿瘤指标等实验室检查无异常发现。超声提示左侧阴囊内实性占位,血流信号丰富。核磁共振检查提示左侧阴囊内占位。行左侧睾丸根治性切除术,术后病理免疫组化肌间线蛋白Desmin(+),肌细胞生成素Myogenin(+),诊断为睾丸旁横纹肌肉瘤。术后第3天发现左侧阴囊内无痛性肿物,行左侧半阴囊切除术,后采用长春新碱+放线菌素D+环磷酰胺(VAC)方案化疗。现随访8个月,无瘤生存。结论小儿睾丸旁横纹肌肉瘤表现为阴囊内占位性病变,因特殊的生长位置易误诊为睾丸肿瘤。完整的手术切除及病理学检查可以对该类病变进行治疗并明确诊断。

Objective To explore the clinical characters and treatment of paratesticular rhabdomyosarcoma(RMS)in children.Methods The clinical data of a child patient with paratesticular RMS was retrospectively analyzed and the related literatures were reviewed.Results The patient presented with a progressively enlarging mass in left scrotum.Biochemical test,immunologic test,tumor marker showed no abnormalities.Ultrasound demonstrated a solid lesion in the left scrotum with rich blood supply signals inside.Enhanced magnetic resonance showed the same result as ultrasound.Radical left testicular resection was performed.Pathological diagnosis was paratesticular RMS with positive result of Desmin and Myogenin.A painless mass was found in the left scrotum on the third day after operation,then left scrotum resection was performed.VAC chemotherapy was used after operation.Follow-up for 8 months,the patient survived with tumor free.Conclusions The paratesticular RMS can present as a mass in scrotum and is easily considered to be carcinoma of testis because of its location.Correct diagnosis and reasonable treatments can be made by pathologic examination after radical resection.