Lararoscopic Retroperitoneal Lymph Node Dissection for Paratesticular Rhabdomyosarcoma in Older Children/Adolescents

Testicular tumors are far more common in adults than in children. For this reason, management of pediatric testis tumors has been based on experience in adults. However, there are important differences between testis tumors occurring in children and those occurring in adults. These differences involve tumor histopathology, malignant potential, and pattern of metastatic spread [1]. The majority of primary testis tumors in the Prepubertal Testis Tumor Registry of the Urologic Section of the American Academy of Pediatrics were yolk sac tumors, followed by teratomas and stromal tumors. Because teratomas and most stromal tumors are benign in children, it would follow that fewer than two thirds of prepubertal testis tumors have malignant potential, compared with 90 % of tumors in adults. It is even possible that the majority of prepubertal tumors are benign. Several single-center studies suggest that teratomas are more common than yolk sac tumors in pediatric patients; however, these studies were not limited to prepubertal patients [2–5] . Paratesticular rhabdomyosarcomas usually present with an enlarging painless scrotal mass. By the time they present it is usually not possible to distinguish from a primary testis tumor on physical examination, though the extra-testicular nature of the tumor is usually apparent on ultrasound. Trans-scrotal biopsies of solid scrotal masses should be avoided due to the risk of seeding of the incision if the mass is indeed a rhabdomyosarcoma. The excision of the tumor should be performed just as for a testicular malignancy. The metastatic evaluation for paratesticular rhabdomyosarcoma includes a CT (Computed tomography) of the chest, abdomen, and pelvis. A majority of patients will have clinical stage 1 disease. The most common sites of metastases are the retroperitoneum and lungs. Patients with retroperitoneal metastases should undergo a modified unilateral nerve-sparing RPLND (Retroperitoneal lymph node dissection). All patients should receive chemotherapy and those with positive retroperitoneal nodes should receive radiation therapy as well [1]. We report on two older children/adolescents who underwent Laparoscopic-RPLND.