R habdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children constituting 3.5% of all cancers in them with the head and neck as the predominant site. RMS has a propensity to metastasize to the bone, bone marrow, lung, liver, brain, and lymph nodes in 14-28%, whereas, to the breast in 3.7-6.7% of cases [1,2]. Hays et al. (92%), Howarth et al. (86%), and D'Angelo et al. (100%) have observed alveolar RMS as the predominant histological subtype metastasizing to the breast [2]. Fine-needle aspiration cytology (FNAC) being a quick, safe, and economical technique, thus acquires an important role in providing morphological diagnosis for timely management [3]. FNAC smears show increased cellularity of discohesive, homogenous small round tumor cells with mildto-moderate cytological atypia, fine granular chromatin, and conspicuous nucleoli in a tigroid background [4].Histomorphology of trucut biopsy from the lesion shows primitive round to spindle cells having scant cytoplasm, hyperchromatic nuclei with admixed scattered rhabdomyoblasts exhibiting brightly eosinophilic abundant cytoplasm, and eccentric hyperchromatic nuclei. These tumor cells are immunopositive for desmin, muscle-specific antigen (MSA), myogenin, and negative for pan-cytokeratin, CD45, CD99, and synaptophysin, therefore, a definitive diagnosis of metastatic RMS of the breast was offered. The treatment of metastatic RMS of the breast comprises chemotherapy, radiotherapy, or surgery depending on the clinical profile. Embryonal RMS has a more favorable prognosis than alveolar or pleomorphic subtypes [5].
CASE REPORTA 16-year-old girl presented 2 years back with complaints of swelling over the right cheek and associated intermittent, scanty bleeding from the nose for 2 months duration. Contrast-enhanced computed tomography (CECT) of the nose and paranasal sinus revealed a large, heterogeneously enhancing soft-tissue mass in the right maxillary antrum associated with thinning/erosion of its wall thus suggestive of neoplastic etiology. Positron emission tomography-CT scan revealed FDG avid, heterogeneously enhancing soft-tissue mass in the right maxillary sinus measuring 5.1×4.3×5.4 cm with extension to the right ethmoidal, sphenoidal sinuses and reported as mitotic pathology.Biopsy from the right maxillary mass was reviewed at our hospital and diagnosed as embryonal RMS.