Metastatic Alveolar Rhabdomyosarcoma with Extensive Bone Marrow Replacement in an Older Adult

Abstract

Rhabdomyosarcoma is extremely rare in adults. Metastatic rhabdomyosarcoma can resemble other malignancies, which can delay diagnosis and prompt treatment. This case illustrates an example of metastatic alveolar rhabdomyosarcoma with concurrent bone marrow infiltration. A 67-year-old woman presented with epistaxis and diffuse bone pain. She developed progressive thrombocytopenia requiring platelet transfusions. The patient was initially thought to have leukemia. She was found to have a large sinonasal mass with extensive metastatic disease and bone marrow infiltration. The patient was ultimately diagnosed with metastatic alveolar rhabdomyosarcoma. She was started on chemotherapy with vincristine, actinomycin, and cyclophosphamide. Unfortunately, she died prior to discharge home. Alveolar rhabdomyosarcoma can resemble a primary bone marrow malignancy when it infiltrates the bone marrow. Further investigation is needed to clarify its clinical behavior and expedite diagnosis and treatment.

High-dose continuous infusion ifosfamide in the treatment of bone marrow infiltration with severe thrombocytopenia in a patient with Ewing sarcoma: a case report

“…Given the aggressiveness of such sarcoma subtypes, most cases were treated with high dose, multidrug regimens with poor responses and severe hematological toxicity, often fatal. [29] Of note, one patient with alveolar rhabdomyosarcoma treated with schedule-adapted VDC/IE had an optimal response with 15-months PFS [30] Chemotherapy, acting on the very first cause of thrombocytopenia, surely has a leading role in the treatment of bone marrow infiltration. All the reported successful cases have in common the administration of low dose, continuous infusion or weekly fractionated chemotherapy regimens, with the aim of reducing the negative impact on hematopoietic bone marrow cells.…”