Differential diagnosis of testicular embryonal rhabdomyosarcoma and testicular seminoma with enhanced CT: a retrospective study.

Authors

Zhixu Zhang, Pan Liang, Songwei Yue, Yonggao Zhang, Hongyan Zhang, Zhigang Zhou, Jianbo Gao

Published in

Frontiers in oncology. Volume 16. Pages 1707887. Epub Jun 03, 2026.

Abstract

Testicular embryonal rhabdomyosarcoma (ERMS) is a rare type of testicular neoplasm. This study aimed to conduct a differential diagnosis between testicular seminoma and testicular ERMS based on enhanced CT features.
In this retrospective study, 15 cases of intratesticular ERMS that were pathologically confirmed and 30 cases of testicular seminoma were collected from December 2012 to May 2024. The general information of the patients was collected, and CT images were retrieved, reviewed, and reanalyzed. CT parameters were measured (the length and short diameter of each lesion, as well as the CT attenuation in the non-enhanced phase, arterial phase, and venous phase), as well as laboratory indicators such as alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and β-human chorionic gonadotropin (β-HCG). Statistical analysis for quantitative data was conducted using an independent sample t-test or a non-parametric test, while the chi-square test was used for qualitative parameters. Further, a receiver operating characteristic (ROC) curve analysis was conducted to test the diagnostic value for differential diagnosis. The existence of postoperative disease progression (recurrence or metastasis) in the two groups was compared using the chi-square test.
A total of 45 patients were involved in the study (15 intratesticular ERMS and 30 testicular seminoma). There were differences in age, CT parameters, and laboratory indicators between rhabdomyosarcoma and seminoma (all p < 0.05). Similarly, the parallel relationship between the lesion and the ipsilateral inguinal region, as well as the vascular ball sign and other signs, also showed statistically significant differences (all p < 0.05). Further single and multi-factor analyses revealed that the parallel relationship between the lesion and the ipsilateral inguinal region, as well as the vascular ball sign, showed statistically significant differences (p < 0.05). The area under the ROC curve (AUC) of the model by logistic regression reached 0.961 [95% confidence interval (CI), 0.857-0.996], with a sensitivity of 86.7% and a specificity of 96.7%. Furthermore, the probability of postoperative disease progression of testicular ERMS is significantly higher than that of testicular seminoma (66.67% vs. 3.3%). Among the 15 ERMS patients, 10 cases (66.7%) had postoperative disease progression, including five cases of recurrence and five cases of distant metastasis. The median time to progression was 7 months (range 2-16.5 months).
The existence of a parallel relationship between the lesion and the ipsilateral inguinal region, as well as the vascular ball sign, is helpful in differentiating testicular ERMS from testicular seminoma.

PMID:
42318479
Bibliographic data and abstract were imported from PubMed on 19 Jun 2026.

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