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Aye JM, Xue W, Palmer JD, Walterhouse DO, Arnold MA, Heaton TE, Venkatramani R. Suboptimal outcome for patients with biliary rhabdomyosarcoma treated on low-risk clinical trials: A report from the Children's Oncology Group. Pediatr Blood Cancer 2021; 68:e28914. [PMID: 33501771 PMCID: PMC8765674 DOI: 10.1002/pbc.28914] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Biliary rhabdomyosarcoma (RMS) is the most common biliary tumor in children. The biliary tract is classified as a favorable primary site. Therefore, patients with localized biliary RMS were included in two consecutive low-risk studies, D9602 and ARST0331, by the Children's Oncology Group (COG). The outcome for these patients treated with low-risk therapy has not been reported. PROCEDURE Patients with biliary RMS enrolled on COG low-risk trials D9602 or ARST0331 were analyzed. All patients received systemic chemotherapy and those with Group II (microscopic residual) or Group III (macroscopic residual) disease received 36-50.4 Gy adjuvant radiotherapy (RT). Delayed primary excision (DPE) was allowed on both studies. RESULTS Seventeen patients with biliary RMS were treated on D9602 (n = 7) or ARST0331 (n = 10). Median age was 3.5 years (range 1.7-10.3). Ten (59%) patients had tumors >5 cm and 14 (82%) had Group III disease. Fifteen (88%) patients received RT. The 5-year event-free survival (EFS) and overall survival (OS) were 70.6% (95% confidence interval [CI]: 46.9-94.3%) and 76.5% (95% CI: 54.6-98.4%), respectively. The majority of patients (80%) who received RT did not have disease recurrence while both patients who did not receive RT had local relapse. Five (36%) of 14 patients with Group III disease underwent DPE; two experienced a local relapse. In the nine patients without DPE, two developed local relapse. CONCLUSIONS Patients with localized biliary RMS treated on low-risk studies had suboptimal outcomes. These patients may benefit from therapy on intermediate-risk studies.
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Affiliation(s)
- Jamie M. Aye
- Department of Pediatrics, Children’s of Alabama, University of Alabama at Birmingham
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida
| | - Joshua D. Palmer
- Department of Radiation Oncology, Wexner Medical Center, The Ohio State University
| | - David O. Walterhouse
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, Children’s Hospital Colorado, University of Colorado
- Department of Pathology, University of Colorado Anschutz Medical Campus
| | - Todd E. Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
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Al Quran T, Rousan L, Aljaafreh A, Bataineh Z. Laparoscopic management of Rhabdomyosarcoma of common Bile duct, Case report. Ann Med Surg (Lond) 2020; 59:118-121. [PMID: 33005400 PMCID: PMC7519210 DOI: 10.1016/j.amsu.2020.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Embryonal Rhabdomyosarcoma (ERMS) is a malignant soft tissue musculoskeletal tumor which constitutes about 0.06% of all malignancies affecting children. Biliary tract ERMS is still rare, though it is considered the most common cause of malignant obstructive jaundice in children. CASE PRESENTATION A report of a 2-year-old boy, who was presented with recurrent episodes of scleral icterus of three months duration, is added to the related literature. His labs went with obstructive jaundice and the radiological investigations were consistent with a diagnosis of choledochal cyst. The found mass was suspected to be an ERMS of common bile duct and turned out to be so by the histopathology. He was managed totally by laparoscope, both excision and hepaticojejunostomy reconstruction, which is an extremely uncommon entity. CONCLUSION Common Bile Duct Rhabdomyosarcoma is rare and diagnosis at this anatomical site is difficult. Our case highlights the feasibility of laparoscopic resection and hepaticojejunostomy reconstruction with very good results at 16-month follow up and parents' gratitude as well.
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Affiliation(s)
- T.M. Al Quran
- Department of Public Health/Community Medicine and Family Medicine, Jordan
| | - L.A. Rousan
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan
| | - A.M. Aljaafreh
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Jordan
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Bayramoglu Z, Kebudi R, Yilmaz R, Buyukkapu Bay S, Kebudi A, Karanlik H, Iribas A, Darendeliler E, Onder S, Bilgic B, Adaletli I. Primary Rhabdomyosarcoma of the Breast: Imaging Findings and Literature Review. Breast Care (Basel) 2018; 13:293-297. [PMID: 30319332 DOI: 10.1159/000487750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature. Case Report A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted. Conclusion A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
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Affiliation(s)
- Zuhal Bayramoglu
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rejin Kebudi
- Pediatric Hematology-Oncology Section, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.,Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ravza Yilmaz
- Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sema Buyukkapu Bay
- Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Abut Kebudi
- Department of Surgery and Surgical Oncology, School of Medicine, Maltepe University, Istanbul, Turkey
| | - Hasan Karanlik
- Department of Surgery, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Ayca Iribas
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Emin Darendeliler
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Adaletli
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Nakib G, Calcaterra V, Goruppi I, Romano P, Raffaele A, Schleef J, Pelizzo G. Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst. Rare Tumors 2014; 6:5173. [PMID: 24711907 PMCID: PMC3977170 DOI: 10.4081/rt.2014.5173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 12/28/2022] Open
Abstract
Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.
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Affiliation(s)
- Ghassan Nakib
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia , Turin, Italy ; Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation , Turin, Italy
| | - Ilaria Goruppi
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Piero Romano
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Alessandro Raffaele
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
| | - Jurgen Schleef
- Clinic of General Paediatric Surgery, Children's Hospital Regina Margherita, Citta della Salute e Scienza , Turin, Italy
| | - Gloria Pelizzo
- Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy
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ERCP with intracholedocal biopsy for the diagnosis of biliary tract rhabdomyosarcoma in children. Pediatr Surg Int 2013; 29:659-62. [PMID: 23417547 DOI: 10.1007/s00383-013-3282-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
Abstract
Rhabdomyosarcoma is the most common tumor of the biliary tract in children. Although some features at preoperative radiographic studies (ultrasound, CT, MRI) may be suggestive of BT-RMS, until few years ago the final diagnosis was obtained by either operative or transcutaneous biopsy, thus exposing to a risk of regional dissemination. More recent and still anecdotal, is the histological diagnosis on tissue obtained by transluminal biopsy either during transhepatic cholangiography or endoscopic retrograde cholangio-pancreatography (ERCP), the latter having the major advantage of a much lower risk of loco-regional dissemination. We present two cases of BT-RMS that were histologically diagnosed by intracholedocal biopsy performed during ERCP, after being suspected at conventional imaging.
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Himes RW, Raijman I, Finegold MJ, Russell HV, Fishman DS. Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma. World J Gastroenterol 2008; 14:4823-5. [PMID: 18720547 PMCID: PMC2739348 DOI: 10.3748/wjg.14.4823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biliary rhabdomyosarcoma (BRMS) is an uncommon childhood malignancy which has been managed surgically. We present a case of a 3-year-old boy with BRMS, in whom endoscopic retrograde cholangiopancreatography (ERCP) was successfully used both diagnostically and therapeutically, thus obviating the need for surgery and its attendant risks of morbidity and mortality. We conclude that ERCP is an effective alternative to surgery for BRMS in some patients.
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