An Unusual Case of Alveolar Rhabdomyosarcoma of the Neck in an Adult Patient

Abstract

Rhabdomyosarcoma is the most common soft tissue malignancy in adolescents. It is extremely rare for sarcomas to occur in patients more than 18 years of age. We present a case of rhabdomyosarcoma originating in skeletal muscles on the right side of the neck. Our case demonstrates the importance of considering an extensive differential diagnosis for a neck mass in adults. Our patient was diagnosed with alveolar variant of rhabdomyosarcoma and underwent chemotherapy and radiation therapy, but eventually due to recurrence opted for palliative therapy.

Management challenges of sinonasal alveolar rhabdomyosarcoma in infanthood: case report and literature review

“…[18F]-fluoro-2-deoxyglucose positron emission tomography combined with CTS (FDG-PET/CTS) is very helpful for staging and restaging of the tumour especially in the assessment of response to therapy. 14 Our patient could not afford to do other investigations outside CTS, we had to depend on our clinical acumen to rule out evidences of both regional and distant metastasis throughout the treatment period.…”

“…On histological analysis, aRMS can be confirmed by microscopic visualization of small round rhabdomyoblasts arranged in nests or cards separated by connective tissue trebaculae with focal areas of alveolar architecture. 7,14 However, the alveolar subtype also appeared as loosely arranged, mitotic cells with septae that gave a similar morphologic appearance of the normal alveoli of the lungs as well as spindle cell neoplasm. This made immunohistochemical analysis very important in the definitive diagnosis.…”

“…Three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, proton beam radiotherapy and brachytherapy were far better techniques of implementing radiotherapy in RMS for better outcome and less complications. 12,14 The introduction of brachytherapy in the management of head and neck tumors had gradually become more preferable due to less complication and tissue-sparing advantages. Some specialist reserved radiotherapy for cases presenting with residue or recurrence after initial primary treatment.…”

“…Some specialist reserved radiotherapy for cases presenting with residue or recurrence after initial primary treatment. 7,14 In cases where aRMS reoccured or persisted despite combined treatment modality, second-line therapy with combination of temozolomide and irinotecan can be considered for repeat of treatment. The use of brachytherapy in head and neck tumors had become increasingly popular owing to its superiority in tissue sparing approach.…”

Primary Cutaneous Alveolar Rhabdomyosarcoma in an Elderly Adult: A Rare Potential Mimic of Merkel Cell Carcinoma

“…ARMS also has predilection for the head and neck region but may arise in the soft tissue of the extremities as well. 3,5,7,8 ARMS is very rare in adults older than 45 years. 9 RMS of any type very rarely presents as a primary cutaneous lesion without underlying soft tissue involvement.…”