Retroperitoneal alveolar rhabdomyosarcoma intruding into spinal canal: A case report and literature review

Abstract

BackgroundRhabdomyosarcoma (RMS) is the most frequent soft sarcoma in children and adolescents. Alveolar rhabdomyosarcoma (ARMS) is a relatively rare subtype that is characterized by aggressive behavior and an unsatisfactory prognosis. An ARMS can arise anywhere but most commonly occurs at extremity sites with a very small fraction in the retroperitoneum. The utility of 2-Deoxy-2-[fluorine-18]-fluoro-D-glucose (18F-FDG) positron emission tomography combined with computed tomography (PET/CT) remains to be established in ARMS.Case ReportA 3-year-old female child was accidentally found with a large left upper abdominal mass for a day. CT examination indicated a huge soft tissue mass in the left retroperitoneum extending superiorly to the level of the left hilus renalis and inferiorly to the left acetabulum in the pelvic cavity, with intrusion into the lumbar foramens. 18F-FDG PET/CT found a mass in the left retroperitoneum from the level of T12 to the left acetabulum, with the maximum standardized uptake value (SUVmax) of about 7.0, and a CT value of about 39 HU, invading the left L3-5 intervertebral foramina and protruding into the spinal canal, with unclear boundary with the spinal cord. Retroperitoneal tumor resection and the repair operation of vascular exploration were performed. An ARMS was confirmed by postoperative biopsy, immunohistochemical staining, and genetic detection with the rupture of the fork head in rhabdomyosarcoma (FKHR). The patient received chemotherapy and was in a good condition with no recurrence and obvious complications.ConclusionRetroperitoneal ARMS is rare and indicates a poor outcome with the potential to involve vital organs and intrude into the spinal canal. Accurate diagnosis and staging using PET/CT would contribute to better risk stratifications and appropriate treatment individually.

The Value of Methods for Diagnosing Alveolar Rhabdomyosarcoma: A Clinical Case

“…Currently, leukemia/lymphoma and other hematopoietic malignancies' diagnosing relies mainly on immunophenotyping results [1,2], in addition to cytomorphological/histopathological and molecular data [3,4]. In contrast, the definitive diagnosis of non-hematopoietic (solid) tumors is based on histopathological examination of tissue samples followed by IHC staining for relatively broad panels of markers and further molecular studies in specific diagnostic tumor subtypes [5].…”

“…In contrast, the definitive diagnosis of non-hematopoietic (solid) tumors is based on histopathological examination of tissue samples followed by IHC staining for relatively broad panels of markers and further molecular studies in specific diagnostic tumor subtypes [5]. This approach, used for diagnostic screening of solid tumors in general, is time-consuming, resulting in a delay in the final diagnosis in a significant proportion of patients [1][2][3][4].…”

“…MFC can simultaneously assess several tumor cells [6]. Nevertheless, MFC is not part of routine diagnostics of solid tumors [4][5][6]. It is mainly due to the need to obtain (fresh) suspensions of individual cells and that, unlike IHC, MFC does not provide information on the structure and location of tumor cells in tissues [7].…”