Radiation-induced mandibular adult spindle cell rhabdomyosarcoma

Dedifferentiated liposarcoma with heterologous spindle cell rhabdomyoblastic de-differentiation: An unusual pattern expanding the morphological spectrum

Dedifferentiated liposarcoma (DDLS) is characterized by a wide histopathological spectrum. Spindle cell type of rhabdomyoblastic dedifferentiation has been rarely described in case of DDLS. A 39-year-old male presented with a recurrent retroperitoneal tumor mass, diagnosed as well-differentiated liposarcoma, for which he underwent surgical excisions on two occasions, followed by adjuvant radiation therapy previously. Computed tomogram scan his of abdomen revealed a large-sized, fat-containing recurrent, retroperitoneal mass, measuring 18.1 cm in the largest dimension. Histopathologic examination of the resected tumor revealed distinct areas of well- and dedifferentiated liposarcoma, including areas reminiscent of a myxofibrosarcoma, further progressing into a high-grade spindle cell sarcoma with fascicular and "Herringbone-like" growth patterns (fibrosarcoma-like). Immunohistochemically, high-grade spindle cell sarcomatous (dedifferentiated) component displayed distinct positivity for desmin and MyoD1, along with focal tumor nuclei, showing nuclear positivity for myogenin. Both well-differentiated liposarcomatous and dedifferentiated components displayed diffuse, intense nuclear positivity for MDM2 (overexpression) and p16INK4A. Furthermore, upon testing tumor sections displaying spindly sarcomatous areas for MDM2 amplification, by FISH technique, nearly all tumor cells displayed MDM2 gene amplification. This case constitutes one of the rare cases of DDLS displaying spindle cell rhabdomyoblastic dedifferentiation. Its diagnostic and treatment implications are discussed herewith.

Alveolar rhabdomyosarcoma of the mandible in an adult invading the parotid gland: A rare case report

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Rhabomyosarcoma (RMS) can be localized in the cervico-facial region and in an adult.

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Its diagnosis is histological with an immunohistochemical study.

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RMS in adults require neoadjuvant chemotherapy combined with locoregional treatment by tumor excision surgery followed by radiotherapy.

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RMS of the head and neck of adults have a poor prognosis.

Introduction

Rhabdomyosarcoma (RMS) is a malignant mesenchymal neoplasm uncommon in adults.

Presentation of case

We report the case of an alveolar rhabdomyosarcoma in a rare location and in an adult. It concerns a 46-year-old woman with a mandibular location invading the parotid gland. The Immunohistochemical analysis revealed intense positivity for myogenin and desmin, favoring the diagnosis of alveolar rhabdomyosarcoma. The patient had a right hemi-mandibulectomy with parotidectomy and received chemotherapy with radiotherapy. The evolution was good up to 2 years postoperatively then the patient relapsed with a recurrence of tumour rapidly progressing and metastases in the cervical spine.

Discussion

RMS is an aggressive but rare disease that is one of the most common malignant head and neck tumors in children. The predilection sites of adult rhabdomyosarcoma are the extremities. Current treatment includes a combination of ablative surgery, chemotherapy, and radiation therapy.

Conclusion

The prognosis of head and neck rhabdomyosarcomas in adults remains very poor given the often initially advanced stage of the disease and the high metastatic potential.

Orbito-ethmoidal rhabdomyosarcoma in an adult patient: a case report and review of the literature

We report a patient who presented to the ENT service complaining of nasal obstruction, exophthalmos, edema and ipsilateral facial congestion. Imaging studies revealed an aggressive noncalcified solid mass centered in the left nasoethmoidal region and heterogeneous avid enhancement following contrast media injection. Subsequently, a biopsy confirmed the presence of solid alveolar rhabdomyosarcoma. The patient was treated with chemoradiation therapy for 7 weeks. Due to the advanced stage of the disease, the patient was enrolled in a palliative care and pain control program.

Rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region

Radiation-induced sarcomas of the head and neck are rare and tend to occur decades after treatment. We report a case of rapid-onset postchemoradiotherapy rhabdomyosarcoma of the maxillofacial region and briefly review the literature.

Spindle cell rhabdomyosarcoma: a brief diagnostic review and differential diagnosis

Spindle cell rhabdomyosarcoma is a rare variant of embryonal rhabdomyosarcoma that has a predilection for young males and most commonly involves the paratesticular region followed by head and neck. Histopathology demonstrates elongated spindle cells with fusiform to cigar-shaped nuclei and indistinct eosinophilic cytoplasm arranged in fascicles or whorls. Although the tumor demonstrates increased cellularity and moderate atypia, the microscopic and architectural patterns can allow this tumor to be confused with multiple entities, such as leiomyosarcoma, spindle cell carcinoma, desmoplastic melanoma, or fibrosarcoma, with important therapeutic implications. Immunohistochemical workup demonstrates sarcomeric differentiation with reactivity for desmin, myogenin, and MyoD1 markers. Compared with other subtypes, the spindle cell variant in children is associated with a favorable outcome; however, in the adult population there does not appear to be any prognostic advantage.

Rhabdomyosarcoma arising in a previously irradiated field: an analysis of 43 patients

Patients with soft tissue sarcomas that arise from previously irradiated fields have traditionally been reported to have a poor prognosis. In this report, we examined the characteristics and outcomes of patients who developed a rhabdomyosarcoma in a previously irradiated field (RMS-RIF); we hypothesize that these patients should have a better outcome compared to other postradiation soft tissue sarcomas as these tumors are chemosensitive and radiosensitive. A PubMed search of the literature from 1961-2010 yielded 33 studies with data for patients with RMS-RIF. The study included 43 patients with a median age of 6.5 years at the time of radiation therapy (RT) for the initial tumor. The median RT dose was 48 Gy. The median latency period, the time from RT to development of RMS-RIF, was 8 years. The 3-year overall survival for RMS-RIF was 42%. The 3-year overall survival was 66% for patients receiving chemotherapy and local treatment (surgery and/or RT) compared to 29% for those who had systemic treatment only or local treatment only (P=.049). Other factors associated with increased 3-year overall survival included retinoblastoma initial diagnosis (P<.001), age ≤ 18 years at diagnosis of RMS-RIF (P=.003), favorable site (P=.008), and stage 1 disease (P=.002). Age at time of RMS-RIF, retinoblastoma initial tumor, favorable site, stage 1 disease, and use of both systemic and local treatment were found to be favorable prognostic factors for 3-year overall survival.