International Journal of Medicine and Medical Sciences Vol 1.(11) pp. 470-472, November, 2009 Available online http://www.academicjournals.org/ijmms ISSN 2006-9723 ©2009 Academic Journals Case Report Testicular embryonal rhabdomyosarcoma: A case report Agabus N. Manasseh 1 , Godwins O. Echejoh 1 *, Olugbenga A. Silas 1 , Matthew N. Tanko 2 , Shola K. Jegede 1 and Barnabas M. Mandong 1 1 Department of Pathology, Jos University Teaching Hospital, P. M. B. 2076 Jos, Plateau State 930001, Nigeria. 2 Department of Pathology, University of Botswana, P. M. B. 0022, Gaborone, Botswana. Accepted 14 October, 2009 Rhabdomyosarcoma is one of the most frequent soft tissue sarcomas in children. It is found mostly in children, primarily infants, toddlers, and pre-school pupils. However, pure testicular rhabdomyosarcoma is a very rare tumor and few cases have been reported in literature. The tumor usually presents as a painless testicular enlargement with early dissemination via the blood stream and lymphatics. The origin of this tumor is presumed to be from overgrowth of a sarcomatous area of the teratoma. Here, we present a case of testicular rhabdomyosarcoma in a 15-year-old student with a fatal outcome during chemotherapy. This is actually the first case of pure testicular rhabdomyosarcoma diagnosed in this centre after over 10 years. Key words: Rhabdomyosarcoma, testicular, orchidectomy, chemotherapy. CASE PRESENTATION The index case is a 15-year-old male student who presented with a two months history of right sided testicular swelling that has rapidly increased in size since onset. There was an associated dragging sensation, and no evidence of urinary tract infection. Past medical and surgical histories were also nil of note. He is the first of two sons. He lost his mother about a year earlier to invasive ductal carcinoma of the right breast. There has not been a previous history of cancer recorded in the extended family before now. On physical examination, the mass measured 16 by 6 cm and was firm to hard in consistency; it was irregular in shape and non tender. The mass appeared to be continuous with the right testis, mobile and not fixed to the scrotal skin. Other systems examined were normal. Preliminary fine needle aspiration done at the referring hospital suggested a small round blue cell tumor. On admission at the Jos University Teaching Hospital, chest x-ray, abdominal ultrasound, full blood count, urinalysis, serum urea, electrolyte and creatinine, alpha feto protein and -human chorionic gonadotropin were all normal. No intra-abdominal lymphnode enlargement was visualized at ultrasonography. *Corresponding author. E-mail: ogechejoh@yahoo.com. Tel : +234-803-5976098. However, testicular ultrasonography confirmed a testicular mass that was continuous with the right testis. The left testis was normal. The boy later had a right sided high orchidectomy. GROSS AND MICROSCOPIC FINDINGS At the histopathology laboratory, the tissue which was preserved in 10% formalsaline consists of a firm encapsulated grayish white mass of 16 × 10 × 6 cm and weighing 80 gm. Cut section showed a solid grayish mass of 14 cm diameter attached to the testis. Histology showed sheets of rhabdomyoblasts having round hyperchromatic nucleus and brightly eosinophilic cytoplasm, and several strap cells disposed in a myxoid background (Figures 1a and b). The resection margin was free of tumour cells. A diagnosis of embryonal rhabdomyosarcoma was made. Based on this report he was referred to the surgical oncologist for chemotherapy. All earlier investigations were repeated by the oncologist before the chemo- therapy to form a baseline and to rule out any evidence of occult metastasis with additional investigations like electrocardiogram. They all turned out to be normal. Exactly a month after presentation, he was commenced on a VAC cytotoxic regimen (vincristin, adriamycin and