Vol. 12/ Núm. 3 2025 pág. 2309
https://doi.org/10.69639/arandu.v12i3.1393
Delayed Diagnosis of Scrotal Cancer with Report of Primitive
Cells of Difficult Characterization: A Case Report
Diagnóstico tardío de cáncer escrotal con reporte de células primitivas de difícil
caracterización: Informe de un caso
Luisa María Gaviria
https://orcid.org/0009-0007-5471-3902
Luisagaviria1@hotmail.com
Universidad de los Andes
Bogotá D.C., Colombia
Sebastián Villamizar Castellanos
svillamizarc@unal.edu.co
https://orcid.org/0009-0009-2365-3729
Universidad Nacional de Colombia
Bogotá D.C., Colombia
Gloria Ibis Tirado Romero
gloriatirado1987@gmail.com
https://orcid.org/0009-0000-3759-5448
Fundación Universitaria Ciencias de la Salud
Bogotá D.C., Colombia
Juan Pablo Alzate Granados
juanpabloalzategranados@gmail.com
https://orcid.org/0000-0001-8344-494X
Universidad Nacional de Colombia
Bogotá D.C., Colombia
Daniela Avendaño Burgos
danielaaburgos@hotmail.com
https://orcid.org/0000-0001-6678-0212
Universidad del Rosario
Bogotá D.C., Colombia
Artículo recibido: 18 julio 2025 - Aceptado para publicación: 28 agosto 2025
Conflictos de intereses: Ninguno que declarar.
ABSTRACT
This case report presents a delayed diagnosis of scrotal cancer, a rare but aggressive neoplasm
with complex histological features due to the presence of primitive cells of difficult
characterization. The patient presented with progressive scrotal pain and swelling, leading to the
identification of a scrotal mass through imaging studies and histopathological confirmation.
Management included complete excision of the mass and lymphadenectomy, followed by
adjuvant chemotherapy. Although the patient initially faced a guarded prognosis due to the delay
in seeking medical attention, clinical improvement was observed during follow-up. This case
highlights the importance of testicular and scrotal self-examination as a key tool for the early
Vol. 12/ Núm. 3 2025 pág. 2310
detection of abnormalities, as well as the urgency of seeking timely medical care when suspicious
symptoms arise.
Keywords: scrotal cancer, delayed diagnosis, primitive cells, testicular self-examination,
case report
RESUMEN
Este caso clínico presenta un diagnóstico tardío de cáncer escrotal, una neoplasia poco frecuente
pero agresiva con características histológicas complejas debido a la presencia de células
primitivas de difícil caracterización. El paciente presentó dolor e inflamación escrotal
progresivos, lo que llevó a la identificación de una masa escrotal mediante estudios de imagen y
confirmación histopatológica. El tratamiento incluyó la escisión completa de la masa y
linfadenectomía, seguida de quimioterapia adyuvante. Aunque inicialmente el paciente tuvo un
pronóstico reservado debido a la demora en la consulta médica, se observó una mejoría clínica
durante el seguimiento. Este caso resalta la importancia de la autoexploración testicular y escrotal
como herramienta clave para la detección temprana de anomalías, así como la urgencia de buscar
atención médica oportuna ante la aparición de síntomas sospechosos.
Palabras clave: cáncer escrotal, diagnóstico tardío, células primitivas, autoexploración
testicular, caso clínico
Todo el contenido de la Revista Científica Internacional Arandu UTIC publicado en este sitio está disponible bajo
licencia Creative Commons Atribution 4.0 International.
detection of abnormalities, as well as the urgency of seeking timely medical care when suspicious
symptoms arise.
Keywords: scrotal cancer, delayed diagnosis, primitive cells, testicular self-examination,
case report
RESUMEN
Este caso clínico presenta un diagnóstico tardío de cáncer escrotal, una neoplasia poco frecuente
pero agresiva con características histológicas complejas debido a la presencia de células
primitivas de difícil caracterización. El paciente presentó dolor e inflamación escrotal
progresivos, lo que llevó a la identificación de una masa escrotal mediante estudios de imagen y
confirmación histopatológica. El tratamiento incluyó la escisión completa de la masa y
linfadenectomía, seguida de quimioterapia adyuvante. Aunque inicialmente el paciente tuvo un
pronóstico reservado debido a la demora en la consulta médica, se observó una mejoría clínica
durante el seguimiento. Este caso resalta la importancia de la autoexploración testicular y escrotal
como herramienta clave para la detección temprana de anomalías, así como la urgencia de buscar
atención médica oportuna ante la aparición de síntomas sospechosos.
Palabras clave: cáncer escrotal, diagnóstico tardío, células primitivas, autoexploración
testicular, caso clínico
Todo el contenido de la Revista Científica Internacional Arandu UTIC publicado en este sitio está disponible bajo
licencia Creative Commons Atribution 4.0 International.
Vol. 12/ Núm. 3 2025 pág. 2311
INTRODUCTION
Scrotal cancer represents a low-prevalence clinical entity with aggressive characteristics,
making it a challenge both for early detection and appropriate management (12). Historically, its
occurrence has been associated with specific occupational factors, such as exposure to
hydrocarbons; however, in many cases, including the present one, no clear risk factors are
identified (11). This type of cancer has a high mortality rate when diagnosed at advanced stages,
which often occurs due to the absence of early clinical signs and the tendency of patients to
underestimate changes in the scrotal region (15).
The case described is particularly relevant due to the presence of primitive cells with
difficult histopathological characterization, complicating both the initial diagnosis and precise
tumor classification (8). This underscores the importance of advanced diagnostic tools and the
involvement of oncology specialists. Despite progress in imaging diagnostics and
immunohistochemical techniques, there remains a gap in the medical literature regarding the
optimal management of such pathologies.
This report was made to the purpose of contributing to medical knowledge and raising
awareness about a rare but possibly life-threatening disease by reporting clinical findings,
therapeutic management, and outcomes.
Furthermore, this case highlights the diagnostic challenges in dealing with tumors with
undifferentiated cellular morphology. Even in experienced hands, the diagnosis under such
circumstances may demand large panels of immunohistochemical markers and molecular studies
for achieving a final diagnosis. There is a paucity of such conditions in the literature, thus there
are no standardized treatment guidelines and prognosis (2,5).
The heterogeneity in histologic appearance also raises important questions concerning the
biologic behavior of primitive scrotal tumors. It remains to be determined whether they behave
along the natural history of the other scrotal malignancies or constitute an unusual clinical and
histo-pathological group. Elucidating this may bear important treatment and follow-up strategies
(7).
Presentation of this rare atypical case reinforces the rationale for cooperative multicenter
registries and prospective studies to clarify the natural history of rare genitourinary tumors. It is
hoped that these will ultimately result in better classification systems and personalized treatment
for individuals presenting with similarly complex phenotypes.
CLINICAL CASE
Presentation
A young man in his third decade of life presented to the medical consultation with a history
of several months of progressive swelling in the scrotal region, accompanied by intermittent pain
that had intensified in the weeks prior to his visit. He initially noticed, around mid-June 2024, a
INTRODUCTION
Scrotal cancer represents a low-prevalence clinical entity with aggressive characteristics,
making it a challenge both for early detection and appropriate management (12). Historically, its
occurrence has been associated with specific occupational factors, such as exposure to
hydrocarbons; however, in many cases, including the present one, no clear risk factors are
identified (11). This type of cancer has a high mortality rate when diagnosed at advanced stages,
which often occurs due to the absence of early clinical signs and the tendency of patients to
underestimate changes in the scrotal region (15).
The case described is particularly relevant due to the presence of primitive cells with
difficult histopathological characterization, complicating both the initial diagnosis and precise
tumor classification (8). This underscores the importance of advanced diagnostic tools and the
involvement of oncology specialists. Despite progress in imaging diagnostics and
immunohistochemical techniques, there remains a gap in the medical literature regarding the
optimal management of such pathologies.
This report was made to the purpose of contributing to medical knowledge and raising
awareness about a rare but possibly life-threatening disease by reporting clinical findings,
therapeutic management, and outcomes.
Furthermore, this case highlights the diagnostic challenges in dealing with tumors with
undifferentiated cellular morphology. Even in experienced hands, the diagnosis under such
circumstances may demand large panels of immunohistochemical markers and molecular studies
for achieving a final diagnosis. There is a paucity of such conditions in the literature, thus there
are no standardized treatment guidelines and prognosis (2,5).
The heterogeneity in histologic appearance also raises important questions concerning the
biologic behavior of primitive scrotal tumors. It remains to be determined whether they behave
along the natural history of the other scrotal malignancies or constitute an unusual clinical and
histo-pathological group. Elucidating this may bear important treatment and follow-up strategies
(7).
Presentation of this rare atypical case reinforces the rationale for cooperative multicenter
registries and prospective studies to clarify the natural history of rare genitourinary tumors. It is
hoped that these will ultimately result in better classification systems and personalized treatment
for individuals presenting with similarly complex phenotypes.
CLINICAL CASE
Presentation
A young man in his third decade of life presented to the medical consultation with a history
of several months of progressive swelling in the scrotal region, accompanied by intermittent pain
that had intensified in the weeks prior to his visit. He initially noticed, around mid-June 2024, a
Vol. 12/ Núm. 3 2025 pág. 2312
painless hardening in the right hemiscrotum, which he disregarded due to the absence of other
symptoms. However, by the end of that month, the swelling had increased, and the pain began to
interfere with his daily activities, prompting him to seek medical attention.
His personal medical history revealed no prior illnesses or surgeries. He reported no family
history of cancer, nor any occupational exposure to carcinogenic agents. The patient denied
sexually transmitted infections or toxic habits such as smoking or alcohol abuse. Notably, he cited
financial and logistical difficulties in accessing healthcare, which contributed to the delay in his
consultation. At the time of presentation, the clinical context suggested a neoplasm with
potentially aggressive behavior, given the rapid evolution of symptoms and functional impact.
The physical examination revealed a firm, non-reducible mass in the right hemiscrotum,
with ill-defined borders and local signs of inflammation, including mild erythema and increased
temperature. The lesion was tender to palpation, and there was no fluctuation or evidence of
infection. No inguinal lymphadenopathy was detected, and the contralateral testicle and systemic
examination were unremarkable. These findings led to an urgent referral for imaging and biopsy.
A testicular Doppler ultrasound performed on June 26 confirmed a vascularized intra-
scrotal mass with cystic components. Four days later, a pelvic MRI revealed a neoplasm affecting
the right scrotum with probable infiltration of adjacent bony structures. On July 4, the patient
underwent an excisional biopsy, and histopathological analysis reported a poorly differentiated
tumor composed of small to intermediate-sized cells, with lymphovascular invasion and
necrosis—suggestive of a high-grade malignant neoplasm.
Subsequent staging with CT scans on August 24 identified tumor extension to the penis
and scrotum, as well as metastases to bones and inguinal lymph nodes. Based on these findings,
adjuvant chemotherapy with the VAC protocol—Vincristine, Actinomycin D, and
Cyclophosphamide—was initiated on September 19 as first-line treatment. The first cycle was
well tolerated, and the patient was placed under scheduled oncological follow-up.
Diagnostic Evaluation
The diagnostic process began with a Doppler ultrasound, which revealed a highly
vascularized solid mass in the scrotum. Subsequently, pelvic MRI identified features consistent
with a malignant tumor with aggressive behavior and secondary infiltrative lesions. The biopsy
confirmed the poorly differentiated nature of the tumor, with primitive histological
characteristics. Common tumor markers such as AFP, CK, and CD30 were negative, complicating
precise tumor classification.
Therapeutic Intervention
Initial management included radical surgery for complete resection of the scrotal mass and
bilateral inguinal lymphadenectomy. Subsequently, the patient underwent adjuvant chemotherapy
following the VAC protocol (Vincristine, Actinomycin D, and Cyclophosphamide). This regimen
painless hardening in the right hemiscrotum, which he disregarded due to the absence of other
symptoms. However, by the end of that month, the swelling had increased, and the pain began to
interfere with his daily activities, prompting him to seek medical attention.
His personal medical history revealed no prior illnesses or surgeries. He reported no family
history of cancer, nor any occupational exposure to carcinogenic agents. The patient denied
sexually transmitted infections or toxic habits such as smoking or alcohol abuse. Notably, he cited
financial and logistical difficulties in accessing healthcare, which contributed to the delay in his
consultation. At the time of presentation, the clinical context suggested a neoplasm with
potentially aggressive behavior, given the rapid evolution of symptoms and functional impact.
The physical examination revealed a firm, non-reducible mass in the right hemiscrotum,
with ill-defined borders and local signs of inflammation, including mild erythema and increased
temperature. The lesion was tender to palpation, and there was no fluctuation or evidence of
infection. No inguinal lymphadenopathy was detected, and the contralateral testicle and systemic
examination were unremarkable. These findings led to an urgent referral for imaging and biopsy.
A testicular Doppler ultrasound performed on June 26 confirmed a vascularized intra-
scrotal mass with cystic components. Four days later, a pelvic MRI revealed a neoplasm affecting
the right scrotum with probable infiltration of adjacent bony structures. On July 4, the patient
underwent an excisional biopsy, and histopathological analysis reported a poorly differentiated
tumor composed of small to intermediate-sized cells, with lymphovascular invasion and
necrosis—suggestive of a high-grade malignant neoplasm.
Subsequent staging with CT scans on August 24 identified tumor extension to the penis
and scrotum, as well as metastases to bones and inguinal lymph nodes. Based on these findings,
adjuvant chemotherapy with the VAC protocol—Vincristine, Actinomycin D, and
Cyclophosphamide—was initiated on September 19 as first-line treatment. The first cycle was
well tolerated, and the patient was placed under scheduled oncological follow-up.
Diagnostic Evaluation
The diagnostic process began with a Doppler ultrasound, which revealed a highly
vascularized solid mass in the scrotum. Subsequently, pelvic MRI identified features consistent
with a malignant tumor with aggressive behavior and secondary infiltrative lesions. The biopsy
confirmed the poorly differentiated nature of the tumor, with primitive histological
characteristics. Common tumor markers such as AFP, CK, and CD30 were negative, complicating
precise tumor classification.
Therapeutic Intervention
Initial management included radical surgery for complete resection of the scrotal mass and
bilateral inguinal lymphadenectomy. Subsequently, the patient underwent adjuvant chemotherapy
following the VAC protocol (Vincristine, Actinomycin D, and Cyclophosphamide). This regimen
Vol. 12/ Núm. 3 2025 pág. 2313
was administered over several cycles, with dose adjustments based on the patient’s tolerance. No
severe adverse effects were documented during treatment, and the patient was closely monitored.
Follow-Up and Outcomes
At six months of follow-up, imaging studies showed no evidence of local recurrence or
distant metastases. The patient reported significant improvement in pain and functionality.
Treatment adherence was complete and confirmed through periodic consultations and regular
laboratory testing. The patient expressed satisfaction with the results and committed to his long-
term follow-up plan.
DISCUSSION
Epidemiology and Diagnostic Challenges
Scrotal cancer is a rare clinical entity, with a significantly lower incidence compared to
other genitourinary neoplasms (10). Its presentation is often insidious, and early symptoms, such
as palpable masses or mild swelling, are frequently ignored or underestimated by patients (4).
This delay in seeking medical care is particularly dangerous in aggressive tumors, which can
progress rapidly and metastasize. In the present case, the patient waited several weeks after
symptom onset before consulting, highlighting the need for greater public awareness regarding
scrotal changes and the importance of self-examination.
The diagnostic process was further complicated by the presence of primitive cells with high
mitotic activity and poorly differentiated histological patterns (6). These features impeded the
precise classification of the tumor and complicated therapeutic planning. The negativity of
common tumor markers such as AFP, CK, and CD30 further obscured diagnosis. In this context,
advanced diagnostic tools, including immunohistochemistry and magnetic resonance imaging,
were crucial for clinical decision-making (6).
Given the histopathological overlap with other undifferentiated and high-grade pediatric
tumors, the use of the VAC chemotherapy protocol, comprising Vincristine, Actinomycin D, and
Cyclophosphamide, was adopted. This regimen is well-established in the treatment of pediatric
sarcomas and embryonal tumors, such as rhabdomyosarcoma, and is supported by long-term data
on its efficacy and tolerability in aggressive neoplasms with primitive differentiation. Although
it is not standard for adult scrotal tumors, its use was justified by the absence of a definitive
histological diagnosis, the tumor's biological behavior, and the therapeutic success documented
in similar histological contexts. In this case, although experience with scrotal neoplasms is
limited, the VAC protocol (Vincristine, Actinomycin D, Cyclophosphamide) was selected based
on its favorable short-term tolerability. In adolescents with rhabdomyosarcoma receiving similar
cumulative VAC doses, studies have shown significantly fewer hematologic adverse effects,
supporting its use even in rare, adult-onset presentations (16).
was administered over several cycles, with dose adjustments based on the patient’s tolerance. No
severe adverse effects were documented during treatment, and the patient was closely monitored.
Follow-Up and Outcomes
At six months of follow-up, imaging studies showed no evidence of local recurrence or
distant metastases. The patient reported significant improvement in pain and functionality.
Treatment adherence was complete and confirmed through periodic consultations and regular
laboratory testing. The patient expressed satisfaction with the results and committed to his long-
term follow-up plan.
DISCUSSION
Epidemiology and Diagnostic Challenges
Scrotal cancer is a rare clinical entity, with a significantly lower incidence compared to
other genitourinary neoplasms (10). Its presentation is often insidious, and early symptoms, such
as palpable masses or mild swelling, are frequently ignored or underestimated by patients (4).
This delay in seeking medical care is particularly dangerous in aggressive tumors, which can
progress rapidly and metastasize. In the present case, the patient waited several weeks after
symptom onset before consulting, highlighting the need for greater public awareness regarding
scrotal changes and the importance of self-examination.
The diagnostic process was further complicated by the presence of primitive cells with high
mitotic activity and poorly differentiated histological patterns (6). These features impeded the
precise classification of the tumor and complicated therapeutic planning. The negativity of
common tumor markers such as AFP, CK, and CD30 further obscured diagnosis. In this context,
advanced diagnostic tools, including immunohistochemistry and magnetic resonance imaging,
were crucial for clinical decision-making (6).
Given the histopathological overlap with other undifferentiated and high-grade pediatric
tumors, the use of the VAC chemotherapy protocol, comprising Vincristine, Actinomycin D, and
Cyclophosphamide, was adopted. This regimen is well-established in the treatment of pediatric
sarcomas and embryonal tumors, such as rhabdomyosarcoma, and is supported by long-term data
on its efficacy and tolerability in aggressive neoplasms with primitive differentiation. Although
it is not standard for adult scrotal tumors, its use was justified by the absence of a definitive
histological diagnosis, the tumor's biological behavior, and the therapeutic success documented
in similar histological contexts. In this case, although experience with scrotal neoplasms is
limited, the VAC protocol (Vincristine, Actinomycin D, Cyclophosphamide) was selected based
on its favorable short-term tolerability. In adolescents with rhabdomyosarcoma receiving similar
cumulative VAC doses, studies have shown significantly fewer hematologic adverse effects,
supporting its use even in rare, adult-onset presentations (16).
Vol. 12/ Núm. 3 2025 pág. 2314
Therapeutic Approach and Outcomes
Due to the tumor’s aggressive behavior and uncertain classification, a multimodal
treatment strategy was employed. The patient underwent radical surgery for complete tumor
resection along with bilateral inguinal lymphadenectomy. This was followed by adjuvant
chemotherapy using a regimen based on cisplatin, etoposide, and bleomycin, agents commonly
employed in the treatment of primitive germ cell tumors (3). Although specific data on scrotal
neoplasms are limited, the approach was justified by the clinical scenario and comparable
experiences reported in the literature (3).
The patient tolerated the VAC protocol well, with no severe adverse effects, and showed
no signs of relapse during the initial six-month follow-up. This outcome reinforces the potential
effectiveness of a multimodal therapeutic approach in similar rare cases. Nonetheless, the late-
stage diagnosis necessitated a more complex and aggressive treatment plan, underscoring the
benefits of early detection in avoiding such burdensome interventions (13).
Case Relevance and Future Implications
This case represents a valuable addition to the limited literature on scrotal neoplasms with
primitive histological features. Due to the overlap with other undifferentiated tumors and the
difficulties in classification, it emphasizes the urgent need to establish centralized databases and
cooperative multicenter studies. Such efforts could lead to the development of consensus
diagnostic criteria and enable comparative research to refine therapeutic strategies. The inclusion
of molecular profiling may also provide new opportunities for personalized therapies, particularly
by identifying actionable mutations or predictive biomarkers for specific treatment responses
(1,13).
Furthermore, this report supports the integration of interdisciplinary care involving
specialists in oncology, radiology, and pathology, combined with comprehensive patient support
(6). Multidisciplinary management facilitates more accurate diagnosis and enhances treatment
planning and long-term follow-up, ultimately improving outcomes.
The most critical lesson from this case is that timely diagnosis and treatment are essential to
modify the clinical course of rare, aggressive malignancies such as scrotal cancer. It also
reinforces the importance of implementing community-based preventive strategies, especially
promoting scrotal and testicular self-examination and encouraging early medical consultation.
Healthcare systems must prioritize public education campaigns and ensure equitable access to
specialized services, particularly for underserved populations, to reduce disparities in the
diagnosis and management of these rare urogenital tumors.
Therapeutic Approach and Outcomes
Due to the tumor’s aggressive behavior and uncertain classification, a multimodal
treatment strategy was employed. The patient underwent radical surgery for complete tumor
resection along with bilateral inguinal lymphadenectomy. This was followed by adjuvant
chemotherapy using a regimen based on cisplatin, etoposide, and bleomycin, agents commonly
employed in the treatment of primitive germ cell tumors (3). Although specific data on scrotal
neoplasms are limited, the approach was justified by the clinical scenario and comparable
experiences reported in the literature (3).
The patient tolerated the VAC protocol well, with no severe adverse effects, and showed
no signs of relapse during the initial six-month follow-up. This outcome reinforces the potential
effectiveness of a multimodal therapeutic approach in similar rare cases. Nonetheless, the late-
stage diagnosis necessitated a more complex and aggressive treatment plan, underscoring the
benefits of early detection in avoiding such burdensome interventions (13).
Case Relevance and Future Implications
This case represents a valuable addition to the limited literature on scrotal neoplasms with
primitive histological features. Due to the overlap with other undifferentiated tumors and the
difficulties in classification, it emphasizes the urgent need to establish centralized databases and
cooperative multicenter studies. Such efforts could lead to the development of consensus
diagnostic criteria and enable comparative research to refine therapeutic strategies. The inclusion
of molecular profiling may also provide new opportunities for personalized therapies, particularly
by identifying actionable mutations or predictive biomarkers for specific treatment responses
(1,13).
Furthermore, this report supports the integration of interdisciplinary care involving
specialists in oncology, radiology, and pathology, combined with comprehensive patient support
(6). Multidisciplinary management facilitates more accurate diagnosis and enhances treatment
planning and long-term follow-up, ultimately improving outcomes.
The most critical lesson from this case is that timely diagnosis and treatment are essential to
modify the clinical course of rare, aggressive malignancies such as scrotal cancer. It also
reinforces the importance of implementing community-based preventive strategies, especially
promoting scrotal and testicular self-examination and encouraging early medical consultation.
Healthcare systems must prioritize public education campaigns and ensure equitable access to
specialized services, particularly for underserved populations, to reduce disparities in the
diagnosis and management of these rare urogenital tumors.
Vol. 12/ Núm. 3 2025 pág. 2315
REFERENCIAS
1. Azizi, M., Aydin, A. M., Cheriyan, S. K., Peyton, C. C., Montanarella, M., Gilbert, S. M.,
& Sexton, W. J. (2020). Therapeutic strategies for uncommon testis cancer histologies:
Teratoma with malignant transformation and malignant testicular sex cord stromal tumors.
*Translational Andrology and Urology, 9*(Suppl 1), S91–S103.
https://doi.org/10.21037/tau.2019.09.08
2. Bellizzi, A. M. (2020). An algorithmic immunohistochemical approach to define tumor
type and assign site of origin. *Advances in Anatomic Pathology, 27*(3), 114–163.
https://doi.org/10.1097/PAP.0000000000000256
3. Bouabid, M., Soufiane, B., Bensghier, A., Moukhlissi, M., & Mezouar, L. (2024).
Multimodal therapy for locally advanced scrotal cancer: A case report with a literature
review. *Cureus.* https://www.cureus.com/articles/243605-multimodal-therapy-for-
locally-advanced-scrotal-cancer-a-case-report-with-a-literature-review
4. Clarke, N. W., & McHugh, L. (2010). Management of testicular tumours. *Surgery
(Oxford), 28*(12), 610–616.
5. de Castro, G., Souza, F. H., Lima, J., Bernardi, L. P., Teixeira, C. H. A., & Prado, G. F.
(2023). Does multidisciplinary team management improve clinical outcomes in NSCLC?
A systematic review with meta-analysis. *JTO Clinical and Research Reports, 4*(12),
100580. https://doi.org/10.1016/j.jtocrr.2023.100580
6. Dewan, K., Choudhury, M., Pathania, O., & Singh, S. (2015). Primitive neuroectodermal
tumor in a mixed germ cell tumor: A rare case report. *Clinical Cancer Investigation
Journal, 4*(1), 66.
7. Emerson, R. E., & Ulbright, T. M. (2005). The use of immunohistochemistry in the
differential diagnosis of tumors of the testis and paratestis. *Seminars in Diagnostic
Pathology, 22*(1), 33–50. https://doi.org/10.1053/j.semdp.2005.11.003
8. Essid, M. A., Bouzouita, A., Saadi, A., Blel, A., Chaker, K., Chakroun, M., et al. (2018).
A case report of scrotal squamous cell carcinoma secondary to chronic urinary irritation.
*Cureus.* https://www.cureus.com/articles/11552-a-case-report-of-scrotal-squamous-
cell-carcinoma-secondary-to-chronic-urinary-irritation
9. Harms, D., Zahn, S., Göbel, U., & Schneider, D. T. (2006). Pathology and molecular
biology of teratomas in childhood and adolescence. *Klinische Pädiatrie, 218*(6), 296–
302. https://doi.org/10.1055/s-2006-942271
10. Malavasi, N., Ferrara, L., Fiorani, C., Saviola, A., & Longo, G. (2011). Diagnostic delay
in oncology: A case report of metastatic seminoma. *Case Reports in Oncology, 4*(1),
216–221.
REFERENCIAS
1. Azizi, M., Aydin, A. M., Cheriyan, S. K., Peyton, C. C., Montanarella, M., Gilbert, S. M.,
& Sexton, W. J. (2020). Therapeutic strategies for uncommon testis cancer histologies:
Teratoma with malignant transformation and malignant testicular sex cord stromal tumors.
*Translational Andrology and Urology, 9*(Suppl 1), S91–S103.
https://doi.org/10.21037/tau.2019.09.08
2. Bellizzi, A. M. (2020). An algorithmic immunohistochemical approach to define tumor
type and assign site of origin. *Advances in Anatomic Pathology, 27*(3), 114–163.
https://doi.org/10.1097/PAP.0000000000000256
3. Bouabid, M., Soufiane, B., Bensghier, A., Moukhlissi, M., & Mezouar, L. (2024).
Multimodal therapy for locally advanced scrotal cancer: A case report with a literature
review. *Cureus.* https://www.cureus.com/articles/243605-multimodal-therapy-for-
locally-advanced-scrotal-cancer-a-case-report-with-a-literature-review
4. Clarke, N. W., & McHugh, L. (2010). Management of testicular tumours. *Surgery
(Oxford), 28*(12), 610–616.
5. de Castro, G., Souza, F. H., Lima, J., Bernardi, L. P., Teixeira, C. H. A., & Prado, G. F.
(2023). Does multidisciplinary team management improve clinical outcomes in NSCLC?
A systematic review with meta-analysis. *JTO Clinical and Research Reports, 4*(12),
100580. https://doi.org/10.1016/j.jtocrr.2023.100580
6. Dewan, K., Choudhury, M., Pathania, O., & Singh, S. (2015). Primitive neuroectodermal
tumor in a mixed germ cell tumor: A rare case report. *Clinical Cancer Investigation
Journal, 4*(1), 66.
7. Emerson, R. E., & Ulbright, T. M. (2005). The use of immunohistochemistry in the
differential diagnosis of tumors of the testis and paratestis. *Seminars in Diagnostic
Pathology, 22*(1), 33–50. https://doi.org/10.1053/j.semdp.2005.11.003
8. Essid, M. A., Bouzouita, A., Saadi, A., Blel, A., Chaker, K., Chakroun, M., et al. (2018).
A case report of scrotal squamous cell carcinoma secondary to chronic urinary irritation.
*Cureus.* https://www.cureus.com/articles/11552-a-case-report-of-scrotal-squamous-
cell-carcinoma-secondary-to-chronic-urinary-irritation
9. Harms, D., Zahn, S., Göbel, U., & Schneider, D. T. (2006). Pathology and molecular
biology of teratomas in childhood and adolescence. *Klinische Pädiatrie, 218*(6), 296–
302. https://doi.org/10.1055/s-2006-942271
10. Malavasi, N., Ferrara, L., Fiorani, C., Saviola, A., & Longo, G. (2011). Diagnostic delay
in oncology: A case report of metastatic seminoma. *Case Reports in Oncology, 4*(1),
216–221.
Vol. 12/ Núm. 3 2025 pág. 2316
11. Roush, G. C., Kelly, J. A., Meigs, J. W., & Flannery, J. T. (1982). Scrotal carcinoma in
Connecticut metalworkers: Sequel to a study of sinonasal cancer. *American Journal of
Epidemiology, 116*(1), 76–85.
12. Sarkar, D. (2019). A systematic review of scrotal squamous cell carcinoma. *EMJ
Urology*, 68–74.
13. Sun, Y., Miao, X., Wang, L., Zhang, Y., & Shen, Z. (2023). Surgery for rare
adenosquamous carcinoma of the scrotum: A case report and literature review. *Medicine
(Baltimore), 102*(8), e32994.
14. Unlü, Y., Erdem Huq, G., Ozyalvaçli, G., Zengin, M., Baykal Koca, S., Yücetas, U.,
Bozkurt, E. R., & Behzatoğlu, K. (2015). Paratesticular sarcomas: A report of seven cases.
*Oncology Letters, 9*(1), 308–312.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246635/
15. Verhoeven, R. (2012). Epidemiology of uncommon male genital cancers: Studies with
regional, national and international cancer registry data.
https://www.semanticscholar.org/paper/Epidemiology-of-Uncommon-Male-Genital-
Cancers%3A-with-Verhoeven
16. Gupta, A. A., Pappo, A., Saunders, N., Hopyan, S., Ferguson, P., Wunder, J., & Gupta, S.
(2014). Clinical outcomes in adolescents with rhabdomyosarcoma: A Canadian
perspective. Sarcoma, 2014, 402–509.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008942/
11. Roush, G. C., Kelly, J. A., Meigs, J. W., & Flannery, J. T. (1982). Scrotal carcinoma in
Connecticut metalworkers: Sequel to a study of sinonasal cancer. *American Journal of
Epidemiology, 116*(1), 76–85.
12. Sarkar, D. (2019). A systematic review of scrotal squamous cell carcinoma. *EMJ
Urology*, 68–74.
13. Sun, Y., Miao, X., Wang, L., Zhang, Y., & Shen, Z. (2023). Surgery for rare
adenosquamous carcinoma of the scrotum: A case report and literature review. *Medicine
(Baltimore), 102*(8), e32994.
14. Unlü, Y., Erdem Huq, G., Ozyalvaçli, G., Zengin, M., Baykal Koca, S., Yücetas, U.,
Bozkurt, E. R., & Behzatoğlu, K. (2015). Paratesticular sarcomas: A report of seven cases.
*Oncology Letters, 9*(1), 308–312.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246635/
15. Verhoeven, R. (2012). Epidemiology of uncommon male genital cancers: Studies with
regional, national and international cancer registry data.
https://www.semanticscholar.org/paper/Epidemiology-of-Uncommon-Male-Genital-
Cancers%3A-with-Verhoeven
16. Gupta, A. A., Pappo, A., Saunders, N., Hopyan, S., Ferguson, P., Wunder, J., & Gupta, S.
(2014). Clinical outcomes in adolescents with rhabdomyosarcoma: A Canadian
perspective. Sarcoma, 2014, 402–509.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008942/