1
|
Bao K, Lu S, Tan J, Hao J. Intraspinal alveolar rhabdomyosarcoma: A case report. Asian J Surg 2023; 46:3250-3251. [PMID: 36914472 DOI: 10.1016/j.asjsur.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Affiliation(s)
- Kuanzhu Bao
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, Yunnan, 650101, PR China.
| | - Shanyu Lu
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, Yunnan, 650101, PR China.
| | - Jun Tan
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, Yunnan, 650101, PR China.
| | - Jingang Hao
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, Yunnan, 650101, PR China.
| |
Collapse
|
2
|
Casey DL, Wexler LH, Wolden SL. Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide. Int J Radiat Oncol Biol Phys 2019; 103:1151-1157. [PMID: 30508617 PMCID: PMC6441953 DOI: 10.1016/j.ijrobp.2018.11.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent trends, including the use of proton therapy and administration of reduced doses of cyclophosphamide, have been adapted in head and neck (HN) rhabdomyosarcoma (RMS) to reduce late morbidity. Our primary goal was to analyze local control and survival outcomes after photon versus proton irradiation in pediatric patients with HN-RMS, with the secondary goal of analyzing the effect of cyclophosphamide dose on disease outcomes. METHODS AND MATERIALS This single-institution cohort study comprised 76 pediatric HN-RMS patients treated with definitive chemoradiation from 2000 to 2018. Fifty-one patients (67%) received intensity modulated photon radiation therapy, and 25 (33%) received proton therapy. RESULTS Local failure (LF) at 2 years was 12.5% for parameningeal RMS and 0% for orbital RMS and other head and neck sites (P = .24). Patients treated with protons were more likely to have received reduced-dose cyclophosphamide (P < .0001). The 2-year LF was 7.9% in the intensity modulated photon radiation therapy cohort versus 14.6% in the proton cohort (P = .07), with no difference in survival outcomes. Cumulative cyclophosphamide dose was significantly associated with 2-year LF: 0% for cumulative dose of >20 g/m2 versus 15.3% for ≤20 g/m2 (P = .04). In parameningeal RMS patients (n = 59), both cumulative cyclophosphamide dose and dose intensity were associated with LF (P = .01). There was a trend toward worse event-free survival for parameningeal RMS patients who received reduced-dose-intensity cyclophosphamide (59.2% vs 70.6%, P = .11). CONCLUSIONS Both dose-intensity and cumulative cyclophosphamide dose seem to play an important role in achieving local control for HN-RMS patients treated with either protons or photons. Longer follow-up is needed to further assess disease outcomes with proton therapy.
Collapse
MESH Headings
- Adolescent
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy/methods
- Cyclophosphamide/administration & dosage
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Male
- Neoplasm Recurrence, Local
- Proton Therapy/adverse effects
- Proton Therapy/methods
- Proton Therapy/statistics & numerical data
- Radiotherapy Dosage
- Radiotherapy, Adjuvant/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Radiotherapy, Intensity-Modulated/statistics & numerical data
- Relative Biological Effectiveness
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Treatment Outcome
- Young Adult
Collapse
Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
3
|
Pop DL, Nodiţi G, Abu-Awwad A, Maliţa DC, Zamfir CL, Grigoraş ML, Vermeşan D, Prejbeanu R, Hărăguş HG, Boşcu AL, Ciupe BC, Deleanu BN, Faur CI, Folescu R. Alveolar rhabdomyosarcoma in an adolescent male patient - case report and current perspectives. Rom J Morphol Embryol 2018; 59:1247-1252. [PMID: 30845308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Alveolar rhabdomyosarcoma (RMS) is a common pediatric malignant mesenchymal tumor, representing half of soft tissue sarcomas and approximately 5% of all cancers. We present the case of an adolescent male patient treated in our Department for a tumoral mass located in the middle third of the forearm. Magnetic resonance imaging (MRI) and angiography-computed tomography (angio-CT) showed a large mass located in the muscles of the anterior compartment of the forearm. Surgical treatment consisted of tumor ablation including segmental resection of the radial and ulnar arteries and of the median nerve, followed by saphenous autograft vascular bypass. The treatment plan was based on tumor type, histological grading (high), age, tumor size greater than 5 cm, unfavorable location, postoperative tumor, node, metastasis (TNM) stage II, presence of microscopic tumoral tissue in the margins of the resected piece, lymph node metastases (N1) and bone metastases (M1) found on positron-emission tomography (PET)-CT according to the German soft tissue sarcoma study (CWS)-IV 2002 protocol. The chemotherapy used Carboplatin and Topotecan. Survival was less than two years after the initial presentation. Adolescent extremity masses should raise suspicion to exclude serious malignancy. Despite early diagnosis and use of multimodal therapies, alveolar RMS prognostic remains unpredictable.
Collapse
Affiliation(s)
- Daniel Laurenţiu Pop
- Department of Orthopedics and Traumatology, "Dr. Pius Brînzeu" Clinical Hospital, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania; ,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Liu H, Zhao W, Huang M, Zhou X, Gong Y, Lu Y. Alveolar rhabdomyosarcoma of nasopharynx and paranasal sinuses with metastasis to breast in a middle-aged woman: a case report and literature review. Int J Clin Exp Pathol 2015; 8:15316-15321. [PMID: 26823887 PMCID: PMC4713673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
Alveolar rhabdomyosarcoma (ARMS) is a common soft tissue tumor in children which can rarely metastasize to the breast in adults. Here we report the rare case of a 42-year-old Asian woman, who was diagnosed with ARMS of the nasopharynx and paranasal sinuses, and got a complete remission (CR) after surgery and chemoradiotherapy. Then the patient relapsed in the unilateral breast seventeen months later. Histology and immunohistochemistry of the primary sites and the breast lesions, combined with FISH, have been performed to confirm the diagnosis of metastatic alveolar rhabdomyosarcoma. With a rational therapeutic regimen of surgery, chemotherapy and radiotherapy, the patient has got a complete remission again.
Collapse
Affiliation(s)
- Hongmei Liu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| | - Wei Zhao
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
- State Key Laboratory of Biotherapy, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
- State Key Laboratory of Biotherapy, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| | - Youling Gong
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
- State Key Laboratory of Biotherapy, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan UniversityChengdu, China
- State Key Laboratory of Biotherapy, West China Hospital, Medical School, Sichuan UniversityChengdu, China
| |
Collapse
|
5
|
Bánusz R, Váradi Z, Varga E, Jakab Z, Garami M, Csóka M. [Diagnosis and treatment of childhood soft tissue sarcomas]. Magy Onkol 2014; 58:59-64. [PMID: 24712008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/01/2014] [Indexed: 06/03/2023]
Abstract
Malignant tumors of mesenchymal origin are called sarcomas. Mesenchymal cells normally mature into skeletal muscle, smooth muscle, fat, fibrous tissue, bone and cartilage. Rhabdomyosarcoma (RMS) arises from immature mesenchymal cells that are committed to skeletal muscle lineage. However, it can also arise in tissues in which striated muscle is normally not found (such as the urinary tract). Undifferentiated sarcomas cannot be ascribed to any specific lineage. Treatment results improved significantly in the last decade by combined treatment (chemotherapy, surgery, irradiation, in some cases targeted therapy). Good treatment results can be achieved in pediatric oncology centers by early diagnosis and adequate treatment according to international treatment protocols.
Collapse
Affiliation(s)
- Rita Bánusz
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| | - Zsófia Váradi
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| | - Edit Varga
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| | - Zsuzsa Jakab
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| | - Miklós Garami
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| | - Monika Csóka
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem ÁOK, Budapest, Hungary.
| |
Collapse
|
6
|
Affiliation(s)
- Anil Kumar Dhull
- Department of Radiation Oncology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
| |
Collapse
|
7
|
Wang K. [Alveolar rhabdomyosarcoma of left testis: report of a case]. Zhonghua Bing Li Xue Za Zhi 2012; 41:128-129. [PMID: 22455894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
8
|
Schoofs G, Braeye L, Vanheste R, Verswijvel G, Debiec-Rychter M, Sciot R. Hepatic rhabdomyosarcoma in an adult: a rare primary malignant liver tumor. Case report and literature review. Acta Gastroenterol Belg 2011; 74:576-581. [PMID: 22319971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Rhabdomyosarcomas are malignant tumors that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children and young adults. In mature adults however there are very rare. The liver as a primary site in adults has only been described in 12 cases. We report a case of a primary alveolar rhabdomyosarcoma of the liver in a 59 year old female, confirmed by histological examination using immunohistochemical analysis (positive actin, desmin, vimentin and myogenin staining) and fluorescent in situ hybridization (FISH) analysis (positivity for PAX3/FOXO1A fusion). The patient underwent primary surgical resection, but presented a few weeks after surgery already with recurrent disease in the abdomen and bone metastasis. Despite initial good response to chemotherapy (doxorubicin/ifosfamide) and stable disease at 12 months after diagnosis, the patient died 31 months after the first presentation secondary to complicated abundant abdominal recurrent disease. We further present a review of the literature on published similar cases since 1979.
Collapse
Affiliation(s)
- G Schoofs
- Department of Gastroenterology, University Hospital Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
9
|
Perez EA, Kassira N, Cheung MC, Koniaris LG, Neville HL, Sola JE. Rhabdomyosarcoma in children: a SEER population based study. J Surg Res 2011; 170:e243-51. [PMID: 21529833 DOI: 10.1016/j.jss.2011.03.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 02/07/2011] [Accepted: 03/02/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine incidence and outcomes for pediatric rhabdomyosarcoma (RMS). METHODS The SEER registry was examined for patients with RMS < 20 y old. RESULTS Overall, 1544 patients were identified for an incidence of 0.4414/100,000 per year. Males outnumbered females 3:2. Tumors were classified as embryonal (67%), alveolar (32%), and pleomorphic (1%). Alveolar and pleomorphic RMS were more common in adolescents, whereas embryonal type was more common in younger children (P = 0.0001). Pleomorphic (47%) and alveolar (39%) RMS commonly presented with distant disease, in contrast to embryonal (25%). Most patients had surgical resection (81%) and radiotherapy (63%). Overall, 5- and 10-y survival was 60% and 57%, respectively. Univariate analysis identified higher survival for age < 10 y, local stage, favorable site, embryonal type, <5 cm tumor size, and surgical resection. Multivariate analysis identified non-embryonal type (HR 1.451), non-favorable site (HR 1.570), no surgery (HR 1.726), age ≥ 10 y (HR 1.734), 1973-1978 diagnosis year (HR 1.730), and distant disease (HR 3.456) as independent predictors of mortality. CONCLUSIONS Embryonal histology, the most common type of pediatric RMS, presents in young children and has better prognosis than alveolar or pleomorphic types. Patients with embryonal tumors, favorable tumor location, age < 10 y, localized disease, and surgical resection have improved survival.
Collapse
Affiliation(s)
- Eduardo A Perez
- Division of Pediatric Surgery and Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | | | | | | |
Collapse
|
10
|
Daramola AO, Banjo AAF, Ajekigbe AT, Popoola AO. Metastatic alveolar rhabdomyosarcoma to the breast: a case report. Niger Postgrad Med J 2008; 15:137-140. [PMID: 18575488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To present the unusual occurrence of a Metastatic Alveolar Rhabdomyosarcoma to the right breast in a young woman, six years after the primary in the right thigh had been surgically excised and treated. A search of the literature from this part of the world showed that this is quite rare as no report of a similar case was found. METHODOLOGY Breast lumpectomy samples submitted were routinely processed to obtain paraffin sections which were then stained routinely with haematoxylin and eosin. Reticulin stain and immunohistochemistry were used to exclude an epithelial lesion. CONCLUSION Metastatic Rhabdomyosarcoma to the breast is a rare condition and is almost exclusive to adolescent females. Routine breast examinations should be mandatory for long term female survivors of primary Rhabdomyosarcomas.
Collapse
Affiliation(s)
- A O Daramola
- Department of Morbid Anatomy, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | |
Collapse
|
11
|
Milanovic R, Vlajcic Z, Zic R, Stanec S, Rudman F, Stanec Z. Alveolar rhabdomyosarcoma of the hand in a 2 year-old child. J Hand Surg Eur Vol 2007; 32:109-10. [PMID: 17049698 DOI: 10.1016/j.jhsb.2006.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/22/2006] [Accepted: 08/31/2006] [Indexed: 02/03/2023]
|
12
|
Puri DR, Wexler LH, Meyers PA, La Quaglia MP, Healey JH, Wolden SL. The challenging role of radiation therapy for very young children with rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2006; 65:1177-84. [PMID: 16682130 DOI: 10.1016/j.ijrobp.2006.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 02/03/2006] [Accepted: 02/06/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate local control and toxicity for very young children treated with multimodality therapy for rhabdomyosarcoma (RMS). METHODS AND MATERIALS From 1990 to 2004, 20 patients<or=36 months at diagnosis were treated at our institution. Nineteen underwent chemotherapy (CMT), surgery and/or intraoperative high-dose-rate brachytherapy (IOHDR), and external-beam radiation (EBRT). Median age was 17 months. Sites included extremity (7), trunk (5), parameningeal (4), orbit (1), head/neck (1), bladder/prostate (1). Histologies consisted of 10 embryonal (53%) and 9 alveolar/undifferentiated (47%). Ten had delayed gross total resection (GTR) at median time of 17 weeks after the start of CMT, and 8 of these underwent IOHDR. Median interval between start of CMT and EBRT was 18 weeks. Median EBRT dose was 36 Gy. EBRT technique was either intensity-modulated (11), three-dimensional (3), or two-dimensional (5). Functional outcome was assessed for patients alive>or=1 year after diagnosis (15) in terms of mild, moderate, or severe deficits. RESULTS Median follow-up was 33 months for survivors and 23 months for all patients. Two-year actuarial local control, event-free survival, disease-specific survival, and overall survival were 84%, 52%, 74%, and 62%, respectively. All patients who began EBRT<or=18 weeks after the start of CMT had their disease controlled locally. Five have mild deficits and 10 have no deficits. CONCLUSIONS A reduced dose of 36-Gy EBRT after delayed GTR may maximize local control while minimizing long-term sequelae for very young children with RMS, but unresectable tumors (e.g., parameningeal) require higher doses. Normal-tissue-sparing techniques such as intensity-modulated radiation therapy and IOHDR are encouraged. Local control may be maximized when EBRT begins <or=18 weeks after initiation of CMT, but further study is warranted. Longer follow-up is required to determine the full extent of late effects.
Collapse
Affiliation(s)
- Dev R Puri
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Jiang SL, Zhou CR. [Alveolar rhabdomyosarcoma of kidney]. Zhonghua Bing Li Xue Za Zhi 2006; 35:189. [PMID: 16630516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
MESH Headings
- Adenoma, Villous/metabolism
- Adenoma, Villous/pathology
- Adenoma, Villous/surgery
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Lymphoma/metabolism
- Lymphoma/pathology
- Lymphoma/surgery
- Male
- Middle Aged
- Myosins/metabolism
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Rhabdomyosarcoma, Alveolar/metabolism
- Rhabdomyosarcoma, Alveolar/pathology
- Rhabdomyosarcoma, Alveolar/surgery
- Ureteral Neoplasms/metabolism
- Ureteral Neoplasms/pathology
- Ureteral Neoplasms/surgery
- Vimentin/metabolism
Collapse
|
15
|
Venkov G, Khristova S, Mavrov K. [Rhabdomyosarcoma of the penis]. Khirurgiia (Mosk) 2006:59-61. [PMID: 18843913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
METHODS A rare case of 16 years old boy with rabdomyosarcoma of the penis is presented. RESULTS The patient was treated with subtotal local excision of the tumor. The treatment was continued with chemotherapy courses. The tumor was histologically verified and immunohistochemically with specifical anti-mussule antibodies. Other cases from world literature are reviewed.
Collapse
|
16
|
Affiliation(s)
- Leslie M Passmore
- Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa, Florida 33601, USA
| | | | | |
Collapse
|
17
|
Abstract
BACKGROUND Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumor rarely found in the genital tract. This tumor is associated with a poor prognosis, especially in the adult population. Equally as rare are non-puerperal uterine inversions secondary to sarcomas. CASE A 21-year-old obese woman was initially evaluated with excessive vaginal bleeding. On exam, a large pedunculated mass protruding from the cervix was seen and biopsy of this mass revealed an alveolar rhabdomyosarcoma. The patient was treated with adjuvant chemotherapy consisting of VAC (Vincristine, Actinomycin, and Cyclophosphamide) for a presumed cervical rhabdomyosarcoma. After five cycles of chemotherapy the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, at which time a complete uterine inversion was noted with the tumor located at the fundus of the uterus. Final pathology showed alveolar rhabdomyosarcoma of the uterus. The patient then received additional postoperative VAC regimen for a total of 10 treatments and remains in good health with no evidence of disease 20 months from diagnosis. CONCLUSION This case report describes the only reported case of uterine inversion secondary to alveolar rhabdomyosarcoma of the uterus and discusses current therapeutic options for adults.
Collapse
Affiliation(s)
- Ashley S Case
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 618 South 19th Street, Old Hillman Building, Room 340, Birmingham, AL 35233, USA.
| | | | | | | |
Collapse
|
18
|
Ozeki Z, Kobayashi S, Machida T, Kobayashi T, Oka K, Ishizaka K, Oka T. [Alveolar rhabdomyosarcoma originating in spermatic cord: a case report]. Hinyokika Kiyo 2004; 50:653-5. [PMID: 15518135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 19-year-old man visited our hospital complaining of swelling of the left inguinal region. A thumb head-sized tumor was palpated through the skin on the left spermatic cord. Tumor resection was performed because it was dissected easily apart from the left spermatic cord. Pathological examination revealed alveolar rhabdomyosarcoma with positive surgical margin. Computed tomographic scanning revealed no retroperitoneal lymph node swelling, and there were no clinical findings of distant metastasis (clinical stage I). Radical inguinal orchiectomy with combined chemotherapy using vincristine, dactinomycin, and ifosfamide (VAI) was performed. He has been alive without any recurrence for 8 years and 8 months after the surgery.
Collapse
Affiliation(s)
- Zen Ozeki
- Department of Urology, Kanto Central Hospital
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE The authors present here 5 cases of continent urinary diversion in rhabdomyosarcoma applying a recently described technique for the Mitrofanoff Principle devised by the authors. METHODS Two previously irradiated rhabdomyosarcoma patients presenting with residual bladder disease and massive sensitive urinary urgency underwent a transverse colonic reservoir with catheterizable stoma. Two other patients presenting with a Bricker conduit underwent conversion into an ileal reservoir. One patient underwent reconstruction after a cystectomy. RESULTS All patients were continent and able to perform continent intermittent catheterization. CONCLUSIONS The technique proved to be feasible for this group of patients. The authors believe that because of its simplicity, it should be an option of continent urinary diversion when the Mitrofanoff Principle is considered.
Collapse
Affiliation(s)
- Ricardo G Freitas
- Division of Pediatric Urology, Department of Surgery/Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
Rhabdomyosarcoma (RMS) is a common childhood malignancy which can rarely be located in the breast. Here, we report two pediatric cases of breast RMS, one primary, the other secondary involvement. Primary one is alveolar, and the other embryonal subtype. Imaging findings with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) and a thorough review of literature are presented.
Collapse
Affiliation(s)
- F Binokay
- Department of Radiology, Faculty of Medicine, Cukurova University, Balcali Adana 01330, Turkey.
| | | | | | | | | | | |
Collapse
|
21
|
McMulkin HM, Yanchar NL, Fernandez CV, Giacomantonio C. Sentinel lymph node mapping and biopsy: a potentially valuable tool in the management of childhood extremity rhabdomyosarcoma. Pediatr Surg Int 2003; 19:453-6. [PMID: 12740706 DOI: 10.1007/s00383-003-0956-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2002] [Indexed: 02/06/2023]
Abstract
Multimodal therapy, involving surgery, chemotherapy and radiation, now dominates the management of rhabdomyosarcoma (RMS) in childhood. Yet, despite improvements in these practices, extremity tumors continue to fare relatively poorly. Several investigators have identified prognostic factors that can be used to direct therapy and predict outcome. These factors include histology and metastatic disease, the latter requiring accurate staging to identify. The presence of lymph node metastases has been shown to be of prognostic significance and is incorporated into pre-treatment staging schemes. Up to 50% of all surgically evaluated nodes and 17% of clinically negative nodes in extremity RMS may harbor tumor, underscoring the increased risk of understaging the disease if accurate lymph node dissection is not undertaken. Despite its importance, there appears to be no standard format by which regional nodal status is evaluated in extremity RMS. Sentinel lymph node mapping and biopsy are a minimally invasive technique, currently used in the staging of adult breast cancer and melanoma. In adults, the technique is associated with optimum nodal yield and low morbidity. We describe a case in which sentinel node mapping and dissection were used to easily and accurately stage a distal upper extremity alveolar RMS in a child with clinically and radiologically negative regional lymph nodes. The procedure yielded no positive nodes, was associated with no morbidity and spared the child more extensive radiotherapy. We propose the further evaluation of this simple and innovative technique in the overall management of this childhood malignancy.
Collapse
Affiliation(s)
- H M McMulkin
- General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | |
Collapse
|
22
|
Chen C, Shu HKG, Goldwein JW, Womer RB, Maity A. Volumetric considerations in radiotherapy for pediatric parameningeal rhabdomyosarcomas. Int J Radiat Oncol Biol Phys 2003; 55:1294-9. [PMID: 12654440 DOI: 10.1016/s0360-3016(02)04290-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the influence of radiation volume on outcome in pediatric parameningeal rhabdomyosarcomas (PM-RMSs). METHODS AND MATERIALS Thirty patients ranging in age from 2 to 18 years (median 6) with PM-RMS were treated at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia between August 1988 and December 1999. The histologic subtypes included embryonal (n = 26), alveolar (n = 3), and undifferentiated (n = 1). Twenty-seven patients had Group III and three had Group IV disease. Twenty-seven patients underwent biopsy only and three subtotal resection. All patients were treated with multiple-agent chemotherapy and external beam radiotherapy. In 8 patients, all of whom had intracranial tumor extension, the tumor and whole brain were treated as the initial volume. In the remaining patients, most of those treated before 1992 were treated to the prechemotherapy (CMT) tumor volume for the entire treatment up to the total dose, which ranged from 45 to 59.4 Gy (median dose 57.9). In contrast, patients treated after 1992 generally received radiation initially to the pre-CMT volume (30.6-40 Gy; median dose 36) followed by a conedown to the post-CMT volume to a final dose of 41.4-55.2 Gy (median 50.4). RESULTS With a median follow-up of 6.2 years (range 2.1-13.3), the actuarial 5-year overall survival, progression-free survival, and local control rate for the entire group was 82%, 76%, and 76%, respectively. Seven failures and five deaths have been documented. In univariate analysis, histologic type, tumor size, and age at diagnosis were found to be predictive of overall survival and local control. No statistically significant difference in overall survival or local control was seen between patients who received a conedown to the post-CMT volume (n = 13) and patients in whom the pre-CMT volume was included for the entire treatment (n = 9). CONCLUSION Radiotherapy delivered to children with PM-RMS using a shrinking field technique with a post-CMT volume boost was effective and appears to give results comparable to those of patients in whom the pre-CMT volume was treated for the entire course. The use of such tailored treatment fields is likely to lead to fewer late effects and warrants further investigation.
Collapse
MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Cranial Irradiation/methods
- Cyclophosphamide/administration & dosage
- Dactinomycin/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Ifosfamide/administration & dosage
- Life Tables
- Male
- Nasopharyngeal Neoplasms/drug therapy
- Nasopharyngeal Neoplasms/mortality
- Nasopharyngeal Neoplasms/pathology
- Nasopharyngeal Neoplasms/radiotherapy
- Nasopharyngeal Neoplasms/surgery
- Neoplasm Staging
- Pennsylvania/epidemiology
- Radiotherapy, Adjuvant
- Radiotherapy, High-Energy/methods
- Retrospective Studies
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/pathology
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/pathology
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Survival Analysis
- Treatment Outcome
- Vincristine/administration & dosage
Collapse
Affiliation(s)
- Changhu Chen
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | | | | | | |
Collapse
|
23
|
|
24
|
Milanovic R, Zganjer M, Cizmić A, Pajić A. Rhabdomyosarcoma of the hand. Med Pediatr Oncol 2001; 37:481. [PMID: 11745881 DOI: 10.1002/mpo.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
25
|
Anton JV, Schultze J, Gstöttner W, Matula C. [Tumors of the anterior skull base. Effects of perioperative imaging on adjuvant radiotherapy planning]. Rontgenpraxis 2000; 53:10-5. [PMID: 10943137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Treatment of anterior skull base tumours is still considered being a major challenge for all involved disciplines. Surgical management, complications, as well as the role of imaging for multimodality treatment options should be evaluated critically. PATIENTS AND METHODS 57 patients underwent interdisciplinary one step trans-basal approaches for resection of benign and malignant anterior fossa tumours. Beside assessment of surgical results and perioperative morbidity, in 13 patients with malignant tumours perioperative imaging was evaluated with regard to further possible radio-oncological treatment options. RESULTS Applying trans-basal approaches radical tumour resection could be achieved in all cases independent of tumor-size (diameter 12-114 mm). Permanent postoperative complications (until 6 months postoperatively) were found in 4 cases (7%), transient complications in 7 cases (12.3%). Evaluation of perioperative imaging showed a heterogen use of different imaging modalities and revealed lack of standardization, hampering further planning of radiation therapy. CONCLUSION Treatment of anterior skull base tumours requires a maximum level of standardization of perioperative imaging, to grant a successful surgical and radio-oncological interdisciplinary patient management.
Collapse
MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/radiotherapy
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/radiotherapy
- Carcinoma, Basal Cell/surgery
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/radiotherapy
- Carcinoma, Neuroendocrine/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Chondrosarcoma/diagnosis
- Chondrosarcoma/radiotherapy
- Chondrosarcoma/surgery
- Combined Modality Therapy
- Esthesioneuroblastoma, Olfactory/diagnosis
- Esthesioneuroblastoma, Olfactory/radiotherapy
- Esthesioneuroblastoma, Olfactory/surgery
- Female
- Follow-Up Studies
- Humans
- Intraoperative Period
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Osteosarcoma/diagnosis
- Osteosarcoma/radiotherapy
- Osteosarcoma/surgery
- Postoperative Complications
- Radiotherapy, Adjuvant
- Rhabdomyosarcoma, Alveolar/diagnosis
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Skull Base Neoplasms/diagnosis
- Skull Base Neoplasms/radiotherapy
- Skull Base Neoplasms/surgery
- Time Factors
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- J V Anton
- Neurochirurgische Universitätsklinik, AKH Wien.
| | | | | | | |
Collapse
|
26
|
|
27
|
Daya H, Chan HS, Sirkin W, Forte V. Pediatric rhabdomyosarcoma of the head and neck: is there a place for surgical management? Arch Otolaryngol Head Neck Surg 2000; 126:468-72. [PMID: 10772299 DOI: 10.1001/archotol.126.4.468] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To review and evaluate the place of surgical treatment in the management of rhabdomyosarcoma of the head and neck in children. DESIGN Retrospective analysis of patient charts from January 1, 1972, to December 31, 1998. SETTING Tertiary pediatric referral center. PATIENTS Twenty-nine consecutive children with nonorbital head and neck rhabdomyosarcoma. INTERVENTIONS Surgery, chemotherapy, and radiotherapy. MAIN OUTCOME MEASURES Disease-free survival and long-term morbidity from treatment. RESULTS Twenty patients had parameningeal and 9 had nonparameningeal head and neck tumors. All were treated with chemotherapy. For 18 patients, diagnostic biopsies were performed and they received radiotherapy. Eleven patients underwent surgery as definitive therapy. Using the Intergroup Rhabdomyosarcoma Study (IRS) staging system, 5 of these 11 patients had complete resection of tumor (IRS group I) and avoided radiotherapy. The other 6 patients required radiation because of compromised, regional, or incomplete resection of tumor. One had undergone regional resection with nodal involvement, and 2 had compromised resections with microscopic residual disease (IRS group II). Three had incomplete resections with gross residual tumor (IRS group III). Only 1 patient who underwent surgery ultimately died from recurrence at 2.7 years after an incomplete resection. The other 10 patients were relapse free at a median follow-up of 3.7 years (range 0.8-21.0 years). Long-term surgical morbidity was seen in 36% (4/11) of the patients and included facial nerve paralysis, trismus, and cosmetic deformity. CONCLUSIONS Children with localized disease of the head and neck are able to undergo complete surgical resection, with low long-term surgical morbidity. By undergoing complete surgical resection, these children are able to avoid radiotherapy and its long-term complications, with no compromise in survival.
Collapse
Affiliation(s)
- H Daya
- Department of Pediatric Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
28
|
Rossbach HC, Lacson A, Grana NH, Barbosa JL. Duchenne muscular dystrophy and concomitant metastatic alveolar rhabdomyosarcoma. J Pediatr Hematol Oncol 1999; 21:528-30. [PMID: 10598666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The authors report the concomitant occurrence of Duchenne muscular dystrophy (DMD) and alveolar rhabdomyosarcoma (RMS). A 4-year-old boy presented with symptoms involving his neuromuscular system that affected primarily his left hip and leg. Duchenne muscular dystrophy was diagnosed. Seven months later, metastatic alveolar RMS in the ipsilateral pelvis was documented. The diagnosis of one major disorder affecting striated muscle (DMD) may have prevented the early detection of another (RMS).
Collapse
Affiliation(s)
- H C Rossbach
- Division of Pediatric Hematology/Oncology, All Children's Hospital, University of South Florida College of Medicine, St. Petersburg, USA
| | | | | | | |
Collapse
|
29
|
Blakely ML, Lobe TE, Anderson JR, Donaldson SS, Andrassy RJ, Parham DM, Wharam MD, Qualman SJ, Wiener ES, Grier HE, Crist WM. Does debulking improve survival rate in advanced-stage retroperitoneal embryonal rhabdomyosarcoma? J Pediatr Surg 1999; 34:736-41; discussion 741-2. [PMID: 10359174 DOI: 10.1016/s0022-3468(99)90366-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED BACKGROUND, METHODS, AND PURPOSE: The authors examined demographic and clinical features, therapy, and outcome of patients with advanced (group III or IV) rhabdomyosarcoma (RMS) of the retroperitoneum and nongenitourinary pelvis treated in the Intergroup Rhabdomyosarcoma Study Group (IRSG) III (1984 to 1991, n = 41) or IV pilot (1987 to 1991, n = 53) studies to assess the role of initial debulking surgery. RESULTS Ninety-four patients with retroperitoneal primary tumors and gross locoregional residual tumor (group III, n = 53) or metastatic disease (group IV tumors, n = 41) were treated with combination chemotherapy (ie, vincristine, dactinomycin, and cyclophosphamide with or without other agents plus radiation therapy, RT) after biopsy only or subtotal resection. These retroperitoneal tumors usually were invasive (T2, 76%). Most patients were younger than 10 years of age (n = 69, 73%), the male to female ratio was 1.4, and tumors usually were embryonal (n = 64, 68%). Overall 4-year failure-free survival (FFS) was 50%; survival was 60%. Survival rate was better for girls (4-year survival rate, 75% v49% for boys; P = .05) and was not significantly different for patients treated in IRS-III (66%) or IRS-IV pilot (52%). However, it was better for patients with embryonal versus alveolar or undifferentiated tumors (4-year survival rate, 70% v 42%; P = .002). In adolescents, RMS is different from that seen in children less than 10 years old; most cases are alveolar or undifferentiated (16 of 29, 55%). Surgery for most (21 of 24) patients with alveolar tumors comprised biopsy only. By contrast, of 64 patients with embryonal tumors, 39 (61%) underwent biopsy only, whereas 25 (39%) had debulking surgery. Patients whose tumors were debulked fared better than those whose tumors underwent biopsy only (4-year FFS rate, 72% v48%; P = 0.03). Patients with group IV embryonal tumors fared unexpectedly better than those with group IV alveolar or undifferentiated tumors (70% versus 42% 4-year survival rate, P < .05), and patients less than 10 years of age with group IV embryonal tumors had 4-year survival rate of 77%, indicating the importance of the biology of these tumors. CONCLUSIONS Multimodal therapy, including multiagent chemotherapy plus RT, appears to improve survival rate in patients with advanced embryonal RMS arising in the retroperitoneum. These data suggest that debulking tumors of embryonal histology improves outcome further. This approach will be assessed in IRSG V.
Collapse
Affiliation(s)
- M L Blakely
- Intergroup Rhabdomyosarcoma Study Group, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Dumortier R, Laffargue P, Leteurtre E, Farez E, Bouretz JC. [Rhabdomyosarcoma of the hand. Apropos of a case confined to the thenar eminence]. ANN CHIR PLAST ESTH 1998; 43:563-6. [PMID: 9882898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A case of alveolar rhabdomyosarcoma of the hand in a 21-year-old patient is reported. In the light of this case, the authors review the literature and analyse the therapeutic implications.
Collapse
Affiliation(s)
- R Dumortier
- Service d'Orthopédie C, Clinique Orthopédie-Traumatologie, Hôpital Roger-Salengro, CHRU de Lille, France
| | | | | | | | | |
Collapse
|
31
|
Abstract
PURPOSE This report describes extremely rare cases of infantile rhabdomyosarcoma with multiple skin nodules. They are of interest not only for their anatomic sites, but also for subsequent cerebral metastases with sudden cranial hypertension. PATIENTS Two infants had multiple skin nodules and excisional biopsy revealed alveolar type rhabdomyosarcomas. The patients were treated with tumor resection and combined chemotherapy without any clinical progression for 9 and 16 months, respectively. RESULTS Evidence of cerebral metastases developed with sudden vomiting and convulsion as the first manifestation. In one patient, urgent radiographic examinations failed to reveal lesions except for dilated cerebral ventricles. Seven weeks after the onset of the neurologic symptoms, only Gd-DPTA-enhanced magnetic resonance imaging (MRI) revealed multiple punctate metastatic lesions hyperintense to the surrounding cerebral tissue. Despite appropriate chemotherapy, both patients had disease progression and died of central nervous system metastases. CONCLUSIONS The authors emphasize the need to recognize the multiple cutaneous presentation of infantile rhabdomyosarcoma and the association of cerebral metastases as a potential and fatal complication. The diagnosis is facilitated by Gd-DPTA-enhanced MRI, particularly when cerebral computed tomography scans fail to disclose metastatic lesions.
Collapse
Affiliation(s)
- F Ito
- Department of Pediatric Surgery and Pediatrics, Nagoya University School of Medicine, Japan
| | | | | | | |
Collapse
|
32
|
Abstract
Soft tissue sarcomas (STS) of the hand are rare in children and adolescents. From 1965 through 1995, 18 children with STS of the hand were treated at our institution. Rhabdomyosarcoma (RMS) was diagnosed in 11 patients; alveolar histological results predominated (7 of 11 cases). Seven patients presented with metastatic disease and died 4 to 23 months (median, 9 months) from diagnosis; their surgical treatment comprised above-elbow amputation (n = 1), local excision (n = 1), and biopsy (n = 5). For the four patients who presented with localized RMS, surgery consisted of wide local excision (n = 1), local excision (n = 2), or ray amputation (n = 1). With an average follow-up of 5.5 years (range, 4 months to 18 years), 3 of the 11 patients diagnosed with RMS still survive (27%). The remaining seven patients presented with nonrhabdomyosarcomatous soft tissue sarcoma (NRSTS); the most common histological variants were epithelioid and malignant fibrous histiocytoma (two cases each). Surgical treatment for these patients comprised ray amputation (n = 3), wide local excision (n = 3), excisional biopsy (n = 1), and regional lymph node dissection (n = 3). One patient received adjuvant multiagent chemotherapy; three patients received supplemental radiotherapy. Six of the seven (85%) patients are alive with no evidence of disease at an average follow-up of 4.7 years (range, 6 months to 12 years).
Collapse
Affiliation(s)
- E Gross
- Department of Surgery, St Jude Children's Research Hospital, University of Tennessee, College of Medicine, Memphis, USA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Alveolar rhabdomyosarcoma is an uncommon tumor occurring mostly in extremities of children and adolescents. This type of tumor located in the uterine cervix has not been reported previously. A case of pure alveolar rhabdomyosarcoma arising from the uterine cervix in a 45-year-old patient and having a very aggressive clinical course is described. The patient presented with rapidly progressive cervical tumor, which was originally diagnosed as mesonephroid adenocarcinoma. She was treated with a radical two-stage surgical procedure and postoperative external beam and intracavitary irradiation. Despite treatment, she developed metastatic disease and died 3 months after the surgery. The aggressive course of the disease at this location was consistent with that of the majority of alveolar rhabdomyosarcoma cases of other sites reported in literature. No standard effective treatment is known for this tumor in adult patients.
Collapse
Affiliation(s)
- J Emerich
- Institute of Obstetrics and Gynaecology, Medical University of Gdańsk,Poland
| | | | | |
Collapse
|
34
|
Johnstone PA, Wexler LH, Venzon DJ, Jacobson J, Yang JC, Horowitz ME, DeLaney TF. Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation. Int J Radiat Oncol Biol Phys 1994; 29:735-45. [PMID: 8040019 DOI: 10.1016/0360-3016(94)90561-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The records of 28 patients with sarcomas of the hand and foot treated at the National Cancer Institute (NCI) between 1977 and 1992 were reviewed to assess local control and functional results. METHODS AND MATERIALS Histologic types included 15 cases of the Ewing's sarcoma family of tumors, 7 cases of alveolar rhabdomyosarcoma, and 6 cases of nonrhabdomyosarcoma soft tissue sarcomas. Median age of all patients was 18 years (range 4-61), with a median potential follow-up of 114 months following diagnosis. Surgery varied from incisional biopsies for Ewing's Sarcoma and rhabdomyosarcoma lesions to complete excision when possible for nonrhabdomyosarcoma soft tissue sarcoma lesions. Amputation was not primarily performed, except in two patients who underwent ray resections of hand lesions (patients 13 and 24). Radiotherapy generally consisted of 50 Gy/25 fractions (fx)/5 weeks for Ewing's Sarcoma, 54 Gy/30 fx/6 weeks for rhabdomyosarcoma, and 63 Gy/35 fx/7 weeks for nonrhabdomyosarcoma soft tissue sarcomas. Chemotherapy was administered on various NCI protocols. RESULTS Actuarial local control for Ewing's Sarcoma was 84% at 5 and 10 years. All but one survivor are capable of hand/foot function for routine activities without orthotic requirements. Five of six patients (83%) who died of metastatic disease had functional distal extremities. Actuarial local control for rhabdomyosarcomas was 100%, with equivalent function. No patient developed a second malignancy in the treatment field. CONCLUSIONS Although equivalent local control may be achieved in these lesions with either amputation or radiotherapy, a prudent management course would be to defer amputation for management of local recurrences. Many patients with these lesions fail in distant sites only and die without local failure. For these patients and for those who remain long-term survivors, we believe a functional hand and foot provides a better quality of life than a prosthesis.
Collapse
MESH Headings
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/drug therapy
- Bone Neoplasms/radiotherapy
- Bone Neoplasms/surgery
- Child
- Child, Preschool
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Foot
- Hand
- Humans
- Male
- Middle Aged
- Neuroectodermal Tumors, Primitive/drug therapy
- Neuroectodermal Tumors, Primitive/radiotherapy
- Neuroectodermal Tumors, Primitive/surgery
- Neuroectodermal Tumors, Primitive, Peripheral/drug therapy
- Neuroectodermal Tumors, Primitive, Peripheral/radiotherapy
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Retrospective Studies
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Sarcoma/drug therapy
- Sarcoma/radiotherapy
- Sarcoma/surgery
- Sarcoma, Ewing/drug therapy
- Sarcoma, Ewing/radiotherapy
- Sarcoma, Ewing/surgery
- Survival Analysis
Collapse
Affiliation(s)
- P A Johnstone
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | | | | | | | | | | | | |
Collapse
|
35
|
Kamii Y, Taguchi N, Tsunematsu Y, Kakizawa Y, Saeki M, Honna T, Nakano M, Hashizume K, Komuro H, Bessho F. Primary chemotherapy for children with rhabdomyosarcoma of the 'special pelvic' sites: is preservation of the bladder possible? J Pediatr Surg 1994; 29:461-4. [PMID: 8201521 DOI: 10.1016/0022-3468(94)90593-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Twenty-one children with rhabdomyosarcoma involving the "special pelvic" sites, defined as such occurring in the bladder, prostate, vagina and uterus, were treated with primary surgery between 1969 and 1977, and with primary chemotherapy beginning in 1978. Among 11 patients in the latter group who were placed in Clinical Group III (according to the classification of the US Intergroup Rhabdomyosarcoma Study (IRS), six showed partial response (PR) and underwent tumorectomy by radical surgery an average of 6 months after the start of treatment, and three showed complete response (CR) and were treated with further chemotherapy in the hope that cystectomy could be avoided. However, in the latter group, the tumor recurred (39 months, 35 months, and 27 months later), and all eventually underwent total cystectomy. Seven of the nine long-term survivors underwent total cystectomy and have premanent urinary-cutaneous stomas. Two had tumor-free bladders, but function was impaired in one because of the effect of irradiation. Normal function was preserved in only one patient in the series, whose tumor was located at the dome of the bladder. To preserve bladder function in children with rhabdomyosarcoma in these sites, more effective forms of chemotherapy will be required.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Cystectomy
- Female
- Follow-Up Studies
- Humans
- Infant
- Male
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/surgery
- Pelvic Neoplasms/drug therapy
- Pelvic Neoplasms/mortality
- Pelvic Neoplasms/pathology
- Pelvic Neoplasms/surgery
- Remission Induction
- Rhabdomyosarcoma/drug therapy
- Rhabdomyosarcoma/mortality
- Rhabdomyosarcoma/secondary
- Rhabdomyosarcoma/surgery
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/secondary
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/secondary
- Rhabdomyosarcoma, Embryonal/surgery
- Survival Rate
- Time Factors
- Treatment Outcome
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/physiopathology
- Urinary Bladder Neoplasms/surgery
Collapse
Affiliation(s)
- Y Kamii
- Department of Surgery, National Children's Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- P D Clegg
- Department of Large Animal Medicine and Surgery, Royal Veterinary College, Hatfield, Herts, UK
| | | |
Collapse
|