When a Scrotal Mass Is More Than It Seems: A Case of Pediatric Paratesticular Rhabdomyosarcoma and Review of the Literature

Paratesticular rhabdomyosarcoma (RMS) is a rare pediatric malignancy often misdiagnosed as benign conditions like epididymitis. We report a 4-year-old boy with paratesticular RMS and retroperitoneal metastasis, initially mistaken for epididymitis. The diagnostic delay resulted in disease progression, necessitating radical inguinal orchiectomy, hemiscrotectomy, and complete multimodal therapy. Literature review identified nine similar misdiagnosed pediatric cases due to atypical presentation. Despite a generally favorable prognosis, early diagnosis, radical orchiectomy, and multidisciplinary management are essential to reduce morbidity and improve survival outcomes in children with paratesticular RMS. Clinicians should consider RMS in children with persistent or atypical scrotal masses to avoid treatment delays.