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Dobrindt EM, Öllinger R, Flörcken A, Märdian S, Schmelzle M, Lurje G, Pratschke J, Schoening W. Primäre Lebersarkome – Empfehlungen zur chirurgischen Therapie. Zentralbl Chir 2022; 148:165-179. [PMID: 35211924 DOI: 10.1055/a-1728-6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Maria Dobrindt
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Robert Öllinger
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anne Flörcken
- Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Märdian
- Zentrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Schmelzle
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Georg Lurje
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wenzel Schoening
- Klinik für Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Nazmul H, Rafiqul I, Kaniz F, Maimuna S, Md. WM, ASM BK, Bishnu PD. [Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1338-1343. [PMID: 33328007 PMCID: PMC7735933 DOI: 10.7499/j.issn.1008-8830.2007118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/16/2020] [Indexed: 06/12/2023]
Abstract
Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.
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Affiliation(s)
- Hassan Nazmul
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Islam Rafiqul
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Fathema Kaniz
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Sayeed Maimuna
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Wahiduzzaman Mazumder Md.
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Bazlul Karim ASM
- Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshDepartment of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh
| | - Pada Dey Bishnu
- Department of Pathology, Faculty of Basic Science and Paraclinical Science, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Guérin F, Rogers T, Minard-Colin V, Gaze MN, Terwisscha S, Van Noesel M, De Corti F, Guillén Burrieza G, De Salvo GL, Kelsey A, Orbach D, Ferrari A, Bergeron C, Bisogno G, Martelli H. Outcome of localized liver-bile duct rhabdomyosarcoma according to local therapy: A report from the European Paediatric Soft-Tissue Sarcoma Study Group (EpSSG)-RMS 2005 study. Pediatr Blood Cancer 2019; 66:e27725. [PMID: 30920113 DOI: 10.1002/pbc.27725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the impact of local therapies on the outcome of patients with liver-bile duct rhabdomyosarcoma (LBDRMS). METHODS Data of 30 patients included in the EpSSG-RMS 2005 study were analyzed. RESULTS The median age at diagnosis was 3 years (11 months-8 years). All patients had non-alveolar histology. Fifteen patients had a tumor > 5 cm and six had enlarged regional lymph nodes on imaging. Eight patients (27%) had primary surgery (1 R0). Six of them received external beam radiotherapy (EBRT). All are in first complete remission (CR1) except one (R1, EBRT+ , local relapse, death). Six patients (20%) received EBRT without surgery: one had local relapse and died. Sixteen patients (53%) underwent delayed surgery, with 12 achieving R0 margins, which were higher than those in the primary surgery group (P = 0.003). Three patients with R0 margins received EBRT; one had a metastatic relapse and died. Nine patients with R0 resection did not receive EBRT, three relapsed locally (two deaths). Four R1 patients received additional EBRT without relapses. Local relapse occurred in two among 19 patients with EBRT and three among 11 without EBRT (P = 0.326). At a median follow-up of 61 months (48-84 months), five patients died; all had a tumor size > 5 cm (P = 0.01). The five-year overall survival was 85% (95% CI, 65-94), and event-free survival was 76% (95% CI, 54-89). CONCLUSION This analysis did not show any significant difference in outcome between irradiated and nonirradiated patients. Local relapse in LBDRMS is related to initial tumor size and is often fatal.
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Affiliation(s)
- Florent Guérin
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol NHS Foundation trust, Bristol, United Kingdom
| | - Véronique Minard-Colin
- Département d'Oncologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sheila Terwisscha
- Department of Paediatric Surgery, Prinses Máxima Centrum voor Kinderoncologie, Utrecht, the Netherlands
| | - Max Van Noesel
- Department of Paediatric Surgery, Prinses Máxima Centrum voor Kinderoncologie, Utrecht, the Netherlands
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children Hospital, Manchester, United Kingdom
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hélène Martelli
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
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Biliary tract rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Associazione Italiana Ematologia Oncologia Pediatrica. TUMORI JOURNAL 2018; 104:232-237. [DOI: 10.5301/tj.5000692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor frequent in children. Biliary duct localization is extremely rare, but it is the most common cause of malignant obstructive jaundice in pediatric patients. Methods: This report describes a series of 10 patients under 18 years of age with biliary tract rhabdomyosarcoma who were enrolled, from 1979 to 2004, in 3 consecutive Italian pediatric cooperative protocols that had been drawn up by the Soft Tissue Sarcoma Committee of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). Results: Considering initial and delayed surgery, tumor resection was achieved in 7 cases, 3 complete with free margins (2 liver transplants) and 4 with microscopic residual disease. Chemotherapy was given to all patients and radiotherapy to 3. At present, 5 patients survive in complete remission 90-200 months after diagnosis while 4 died of disease progression or relapse and 1 of liver transplant-related complications. Conclusions: Better outcomes in this series were associated with the feasibility of conservative surgery due to the favorable location of the tumor, in particular in the common bile duct. Chemotherapy and radiotherapy might obviate the need for demolitive surgery or liver transplant, which were linked to worse outcomes in our series.
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Pater L, Turpin B, Mascia A. Pencil Beam Scanning Proton Therapy for Rhabdomyosarcoma of the Biliary Tract. Cureus 2017; 9:e1747. [PMID: 29226038 PMCID: PMC5716683 DOI: 10.7759/cureus.1747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood with 250-350 cases diagnosed annually in the United States. Biliary tract rhabdomyosarcoma is rare, representing <1% of the RMS cases. Due to its location, resection is clinically challenging, and functional complications exist and persist from biliary obstruction. The anatomical location of this tumor presents both opportunities and challenges for pencil beam scanning proton therapy. Proton therapy offers a dosimetric and clinical advantage by sparing the healthy liver, stomach, contra-lateral kidney and bowel. Motion management and anatomical variations, such as intestinal filling or weight loss, requiring routine dosimetric evaluation and possible adaptive treatment planning, present challenges for the use of proton therapy. By taking advantage of the superior dose distribution of proton radiation, assessing the impact of tumor and anatomy motion, and performing regular dose evaluations, biliary tract RMS is an ideal diagnosis for pencil beam scanning proton therapy.
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Affiliation(s)
- Luke Pater
- Radiation Oncology, University of Cincinnati College of Medicine
| | | | - Anthony Mascia
- Radiation Oncology, University of Cincinnati College of Medicine
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Fernandez-Pineda I, Cabello-Laureano R. Differential diagnosis and management of liver tumors in infants. World J Hepatol 2014; 6:486-495. [PMID: 25068000 PMCID: PMC4110540 DOI: 10.4254/wjh.v6.i7.486] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/21/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
During the first year of life, most of the liver neoplasms are benign in origin, but some of these histologically benign lesions may be challenging in their management. Although most hepatic hemangiomas can be safely observed until involution is documented, some patients will need treatment due to progressive hepatomegaly, hypothyroidism and/or cardiac failure. Large mesenchymal hamartomas may require extensive hepatic resection and an appropriate surgical plan is critical to obtain good results. For malignant neoplasms such as hepatoblastoma, complete surgical resection is the mainstay of curative therapy. The decision about whether to perform an upfront or delayed resection of a primary liver malignant tumor is based on many considerations, including the ease of resection, surgical expertise, tumor histology and stage, and the likely chemosensitivity of the tumor. This article reviews the initial management of the more common hepatic tumors of infancy, focusing on the differential diagnosis and treatment options.
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Nakib G, Calcaterra V, Goruppi I, Romano P, Raffaele A, Schleef J, Pelizzo G. Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst. Rare Tumors 2014; 6:5173. [PMID: 24711907 PMCID: PMC3977170 DOI: 10.4081/rt.2014.5173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 12/28/2022] Open
Abstract
Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.
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Affiliation(s)
- Ghassan Nakib
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia , Turin, Italy ; Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation , Turin, Italy
| | - Ilaria Goruppi
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Piero Romano
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Alessandro Raffaele
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Jurgen Schleef
- Clinic of General Paediatric Surgery, Children's Hospital Regina Margherita, Citta della Salute e Scienza , Turin, Italy
| | - Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
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Elwahab MA, Hamed H, Shehta A, Ali M, Zalata K. Hepatobiliary rhabdomyosarcoma mimicking choledochal cyst: Lessons learned. Int J Surg Case Rep 2014; 5:196-9. [PMID: 24636980 PMCID: PMC3980419 DOI: 10.1016/j.ijscr.2014.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The differential diagnosis of hepatic cystic lesions is a challenging process especially in case of hepatic rhabdomyosarcoma (HRMS) presenting as hepatic cyst. PRESENTATION OF CASE We introduce our experience with a case of HRMS in a 3-year-old female patient who was misdiagnosed to have type IV-A choledochal cyst and definitive correct diagnosis was reached after the pathological and immunohistochemical examination of the surgically resected lesion. This case presentation is followed by important practical messages to hepatobiliary surgeons regarding HRMS. DISCUSSION HRMS is a rare pediatric tumor. Jaundice is the most common presentation of HRMS followed by abdominal pain and vomiting. Great effort is needed to differentiate the tumor from choledochal cyst and infectious hepatitis. Through evaluation using available imaging studies together with clinical anticipation is mandatory for establishing the correct diagnosis. CONCLUSION Differentiation of HRMs from choledochal cyst mandates through evaluation and clinical anticipation. HRMS should be suspected in any child with obstructive jaundice. Once diagnosis is established, multidisciplinary treatment is the best management strategy and it has proved better surgical outcome and long term survival.
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Affiliation(s)
- Mohamed Abd Elwahab
- Gastroenterology Surgical Center, General Surgery Department, Mansoura University, Egypt
| | - Hosam Hamed
- Gastroenterology Surgical Center, General Surgery Department, Mansoura University, Egypt.
| | - Ahmed Shehta
- Gastroenterology Surgical Center, General Surgery Department, Mansoura University, Egypt
| | - Mahmoud Ali
- Gastroenterology Surgical Center, General Surgery Department, Mansoura University, Egypt
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ERCP with intracholedocal biopsy for the diagnosis of biliary tract rhabdomyosarcoma in children. Pediatr Surg Int 2013; 29:659-62. [PMID: 23417547 DOI: 10.1007/s00383-013-3282-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
Abstract
Rhabdomyosarcoma is the most common tumor of the biliary tract in children. Although some features at preoperative radiographic studies (ultrasound, CT, MRI) may be suggestive of BT-RMS, until few years ago the final diagnosis was obtained by either operative or transcutaneous biopsy, thus exposing to a risk of regional dissemination. More recent and still anecdotal, is the histological diagnosis on tissue obtained by transluminal biopsy either during transhepatic cholangiography or endoscopic retrograde cholangio-pancreatography (ERCP), the latter having the major advantage of a much lower risk of loco-regional dissemination. We present two cases of BT-RMS that were histologically diagnosed by intracholedocal biopsy performed during ERCP, after being suspected at conventional imaging.
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Assy N, Nasser G, Djibre A, Beniashvili Z, Elias S, Zidan J. Characteristics of common solid liver lesions and recommendations for diagnostic workup. World J Gastroenterol 2009; 15:3217-27. [PMID: 19598296 PMCID: PMC2710776 DOI: 10.3748/wjg.15.3217] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.
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Perera MTPR, McKiernan PJ, Brundler MA, Hobin DA, Mayer DA, Mirza DF, Sharif K. Embryonal rhabdomyosarcoma of the ampulla of Vater in early childhood: report of a case and review of literature. J Pediatr Surg 2009; 44:e9-e11. [PMID: 19231522 DOI: 10.1016/j.jpedsurg.2008.10.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/17/2008] [Accepted: 10/23/2008] [Indexed: 12/17/2022]
Abstract
Embryonal rhabdomyosarcoma of the ampullary region is a very rare childhood tumor (2 reported cases), and herein we describe a child presenting with obstructive jaundice at early age owing to such tumor in the ampullary region. Successful management with multidisciplinary approach is discussed with reference to the literature.
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Himes RW, Raijman I, Finegold MJ, Russell HV, Fishman DS. Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma. World J Gastroenterol 2008; 14:4823-5. [PMID: 18720547 PMCID: PMC2739348 DOI: 10.3748/wjg.14.4823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biliary rhabdomyosarcoma (BRMS) is an uncommon childhood malignancy which has been managed surgically. We present a case of a 3-year-old boy with BRMS, in whom endoscopic retrograde cholangiopancreatography (ERCP) was successfully used both diagnostically and therapeutically, thus obviating the need for surgery and its attendant risks of morbidity and mortality. We conclude that ERCP is an effective alternative to surgery for BRMS in some patients.
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Une choléstase causée par un rhabdomyosarcome botryoïde du cholédoque chez un nourrisson de 22 mois. Ann Pathol 2008; 28:45-8. [DOI: 10.1016/j.annpat.2007.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2007] [Indexed: 11/24/2022]
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