Abstract
Paratesticular rhabdomyosarcoma is a rare, aggressive malignancy often misdiagnosed as benign scrotal mass in adolescents. We report a 16-year-old male with a painful scrotal mass, diagnosed at a metastatic stage (IRS Group IV) with retroperitoneal and pulmonary metastasis. Despite radical orchidectomy and intensive multimodal chemotherapy, the disease progressed rapidly, and the patient died 18 months later. Immunohistochemistry confirmed rhabdomyoblastic differentiation through Myogenin and MyoD1 expression. This case emphasizes that any adolescent scrotal mass must be considered malignant until proven otherwise, highlighting the need for early diagnosis and specialized management in metastatic cases.