Rhabdomyosarcoma in Adults: Case Series and Literature Review

Pleomorphic rhabdomyosarcoma in adults: a case report

BACKGROUND

Rhabdomyosarcoma is a rare type of soft-tissue sarcoma that is more frequently observed in children and is less common in adults. Rhabdomyosarcoma can occur in any part of the body, including tissues without skeletal muscles. The main subtypes of rhabdomyosarcoma are embryonal, alveolar, and pleomorphic. Pleomorphic rhabdomyosarcoma is a rare variant typically found in adults over 45 years old and is characterized by early metastasis.

CASE PRESENTATION

This article reports a rare case of primary pleomorphic rhabdomyosarcoma in the duodenum of A 67-year-old Iranian male. The patient presented to the hospital with epigastric pain and severe anemia. Abdominal imaging revealed a polypoid mass in the duodenum and antropyloric region of the stomach. Laboratory tests confirmed severe anemia, and an endoscopic biopsy initially misdiagnosed the mass as a poorly differentiated epithelioid gastrointestinal stromal tumor.

CONCLUSION

Following surgery and comprehensive immunohistochemical analysis, the final diagnosis of primary pleomorphic rhabdomyosarcoma in the duodenum was confirmed. This case highlights the diagnostic challenges associated with pleomorphic rhabdomyosarcoma in the gastrointestinal tract and underscores the importance of comprehensive immunohistochemical analysis for accurate diagnosis. The article emphasizes the need for further research to better understand the clinical behavior and optimal management of primary gastrointestinal pleomorphic rhabdomyosarcoma.

A Rare Presentation of Sclerosing-Type Rhabdomyosarcoma in an Underserved Patient: A Case Report

A man in his early 40s, with no previous medical history, presented to the emergency room with right leg swelling. It had started more than one month prior to the presentation, but the patient had not sought medical attention due to lack of insurance. He underwent an ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI). The studies revealed a mass in the right vastus medialis muscle. A biopsy revealed a high-grade rhabdomyosarcoma (RMS) with sclerosing features. The patient started treatment with vincristine, actinomycin D, and ifosfamide (VAI). He continued chemotherapy as an outpatient, but was lost to follow-up. He returned four months later with metastatic disease.

Case Report and review of the literature: esophageal pleomorphic rhabdomyosarcoma

Background

Esophageal rhabdomyosarcoma is an exceedingly rare malignant tumor, with only three cases comprehensively documented in the literature since 1995. Due to its rarity, there is limited information on the epidemiology and diagnosis of this disease, and no standardized treatment protocols have been established. As a result, both the recognition and management of esophageal rhabdomyosarcoma pose significant challenges. The present case report provides valuable insight into the clinical approach to this rare tumor, highlighting the need for further research and investigation to develop more effective diagnostic tools and therapeutic strategies.

Case Presentation

We described the case of a 77-year-old male who presented with dyspepsia and anemia, leading to the discovery of an esophageal lesion. At the index endoscopy, histological findings were consistent with esophageal adenocarcinoma. Consequently, the patient was treated with neoadjuvant chemotherapy and Ivor Lewis esophagectomy. Interestingly, on pathological examination the lesion was identified as a pleomorphic rhabdomyosarcoma of the esophagus. Postoperatively, the patient received adjuvant chemotherapy. Subsequently, a subcutaneous metastatic lesion on his right shoulder was treated with a combination of radiotherapy and surgical excision. The patients died twenty-six months after the initial diagnosis.

Conclusions

Our case represents one of the few reported instances of esophageal rhabdomyosarcoma, a highly rare and aggressive malignancy, and provides valuable insights into the challenges of diagnosing and managing this disease. Moreover, this is one of the first cases of esophageal rhabdomyosarcoma followed up for more than 24 months. However, given the paucity of data on esophageal rhabdomyosarcoma, there remains a significant unmet need for more comprehensive studies to establish standardized diagnostic and therapeutic protocols.

Small bowel metastasis from embryonal rhabdomyosarcoma of the extremity- a case report

Rhabdomyosarcoma is the most common soft tissue tumour in children and adolescents, but extremely rare in adults with comparatively worse outcomes. Metastatic disease is not uncommon, but intra-abdominal metastases are exceedingly rare. We report an unusual case of ileal metastases from an upper extremity rhabdomyosarcoma in a 17-year-old male who presented with abdominal pain during a routine follow-up visit. Laparotomy and ileocecectomy for a perforated ileal mass confirmed metastatic embryonal rhabdomyosarcoma with 1 out of 14 positive lymph node metastases. This case demonstrates that, although rare, intra-abdominal metastases should be considered when patients with a rhabdomyosarcoma present with abdominal complaints.

Embryonal rhabdomyosarcoma of the uterine cervix in an adult female

Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily affecting the first two decades of life. This malignancy presentation in adulthood is rare and is seldom seen. The incidence of this tumor affecting adult females is approximately 0.4 - 1%, with the common site being the vagina. This tumor infrequently involves the cervix. RMS has a poor survival rate and once diagnosed, it requires aggressive management by radical surgery accompanied by chemoradiation. We present a case of an anaplastic variant of embryonal RMS of the uterine cervix presenting as a cervical polyp in a 36-year-old female who complained of dyspareunia and post-coital bleeding.

Baseline Characteristics, Prognostic Factors, and Treatment Outcomes for Adult Patients With Rhabdomyosarcoma (RMS)

BACKGROUND

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood, while in adults it is one of the rarer tumors. Its prognosis is better in children with current treatment modalities; however, it carries poorer prognosis in adults. Recent data on adult RMS is scarce from our part of world. We report outcomes of adult patients with RMS, and with 40 patients; it is the first study to publish such a large data from Pakistan.

METHODS

This was a retrospective study that included 64 adult patients aged 18 years and older. After data extraction and scrutiny, a total of 40 patients were segregated with diagnosis of RMS of various varieties who were treated and followed up subsequently. International Business Machines (IBM) Statistical Package for Social Sciences (SPSS), version 26 (IBM Corp., Armonk, NY) was used to evaluate all of the gathered data.

RESULTS

Embryonal RMS (ERMS) was the most common subtype. Factors favoring better overall survival (OS) at 5 years were absence of nodal and distal metastases, treatment with surgery, margin negative resection, and absence of residual disease on postoperative imaging. Adjuvant radiation therapy (XRT) for positive resection margins as well as for residual disease on postoperative imaging also favored better OS at 5 years. Chemotherapy did impart a trend towards better OS; however, it was not significant. Histopathologic subtype and tumor size did not have any significant impact on outcomes. Median progression free survival (PFS) was 11 months and median OS was 15 months.

CONCLUSIONS

Adult RMS is a rare disease entity with widely heterogeneous clinical picture and poorer outcomes as compared to the disease of childhood and adolescence. Further prospective studies with larger sample size are required to establish role of patient, disease, and treatment-related factors affecting outcomes in our population.