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Huang D, Watal P, Drehner D, Dhar D, Chandra T. Rhabdomyosarcoma With Diffuse Bone Marrow Metastases. Cureus 2022; 14:e21863. [PMID: 35265406 PMCID: PMC8897967 DOI: 10.7759/cureus.21863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
Rhabdomyosarcoma is a highly aggressive cancer that is generally considered a disease of childhood. A vast majority of cases occur in those below the age of 20. Rhabdomyosarcoma can occur in any soft tissue in the body but is primarily found in the head, neck, orbit, genitourinary tract, genitals, and extremities. Prognosis is closely tied to the location of the primary tumor and the extent of metastatic spread. As with most sarcomas, rhabdomyosarcoma has a pattern of hematogenous spread which favors metastasis to the lungs. Other common areas include bone marrows, liver, breasts, and brain. One unusual pattern is the presence of diffuse bone marrow metastases in absence of significant soft tissue disease other than primary (no distant nodal disease, absence of visceral disease in chest and abdomen). Frequently in such cases, patients may have initial presentation similar to hematologic malignancy especially when the primary tumor is not evident. This pattern has been rarely described in the radiology literature. This pattern appears to be well documented in pathology literature. Even more rarely, in some cases, the primary tumor site may not be found after imaging and may remain undetermined even postmortem - only diagnosed by bone marrow aspiration. Awareness of this unique pattern is clearly important for radiologists, especially pediatric radiologists, as misdiagnosis can lead to delay in appropriate treatment that ultimately results in increased mortality. We present a case of rhabdomyosarcoma with this unique pattern of bone marrow metastases in which initial differential diagnosis favored a leukemic picture. This paper will go over the diagnostic techniques utilized throughout our patient’s disease course as well as treatment.
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Cheng JJ, Mott RT, Savage PD, Paluri RK. Metastatic Alveolar Rhabdomyosarcoma with Extensive Bone Marrow Replacement in an Older Adult. Case Rep Oncol 2021; 14:1505-1510. [PMID: 34899243 PMCID: PMC8613543 DOI: 10.1159/000519595] [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: 07/22/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Justin J Cheng
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan T Mott
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul D Savage
- Section of Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ravi K Paluri
- Section of Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Jagdale RV, Pol JN. Alveolar rhabdomyosarcoma of urinary bladder presenting as acute leukemia: A diagnostic trap. INDIAN J PATHOL MICR 2021; 63:623-626. [PMID: 33154320 DOI: 10.4103/ijpm.ijpm_850_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyosarcoma (RMS) masquerading as acute leukemia (AL) is very rare. We report a case which presented as acute leukemia subsequently diagnosed to be Alveolar RMS of Urinary Bladder. Although cases of RMS with leukemic presentation have been reported, to our knowledge this is the first case of Alveolar RMS of Urinary Bladder with leukemic picture at initial presentation. We would like to emphasize that this critical error can have serious consequences on the treatment and outcome of these patients.
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Affiliation(s)
- Rakhi V Jagdale
- Department of Pathology, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Maharashtra, India
| | - Jaydeep N Pol
- The Oncopathology Centre, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
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Ataseven E, Ece D, Özsan N, Kantar M. Vacuolated Blasts in the Bone Marrow of a Child with Rhabdomyosarcoma. Turk J Haematol 2020; 37:70-71. [PMID: 31771321 PMCID: PMC7057750 DOI: 10.4274/tjh.galenos.2019.2019.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Eda Ataseven
- Ege University Faculty of Medicine, Department of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Dilek Ece
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Nazan Özsan
- Ege University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Mehmet Kantar
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Oncology, İzmir, Turkey
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López‐Andrade B, Duran MA, Torres L, García‐Recio M, Lo Riso L, Formica A, Ramos RF, Cerda N, Sampol A. Rhabdomyosarcoma debut masquerading as acute lymphoblastic leukemia: A case report and review of the literature. Clin Case Rep 2019; 7:1545-1548. [PMID: 31428386 PMCID: PMC6693075 DOI: 10.1002/ccr3.2284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/18/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Bone marrow infiltration by alveolar rhabdomyosarcoma is uncommon, some cases can mimicry acute leukemia at presentation and mislead the diagnosis. The integration of diagnostics tests and techniques in uncommon malignancies is important to suspect and reach the diagnosis and avoid delay on treatment. We report a case of alveolar rhabdomyosarcoma bone marrow infiltration associated with hemophagocytosis and cell cannibalism, mimicking acute leukemia at presentation.
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Affiliation(s)
| | - Maria Antonia Duran
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Lourdes Torres
- Servicio Hematología y HemoterapiaHospital Can MisesIbizaSpain
| | - Marta García‐Recio
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Laura Lo Riso
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Alejandro Formica
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Rafael F. Ramos
- Servicio Anatomía patológicaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Niurka Cerda
- Servicio Anatomía patológicaHospital Can MisesIbizaSpain
| | - Antonia Sampol
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
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Tarnowski M, Grymula K, Liu R, Tarnowska J, Drukala J, Ratajczak J, Mitchell RA, Ratajczak MZ, Kucia M. Macrophage migration inhibitory factor is secreted by rhabdomyosarcoma cells, modulates tumor metastasis by binding to CXCR4 and CXCR7 receptors and inhibits recruitment of cancer-associated fibroblasts. Mol Cancer Res 2010; 85:472-83. [PMID: 20861157 DOI: 10.1111/j.1600-0609.2010.01531.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The overexpression of macrophage migration inhibitory factor (MIF) has been observed in many tumors and is implicated in oncogenic transformation and tumor progression. MIF activates CXCR2 and CD74 receptors and, as recently reported, may also bind to the stromal-derived factor-1 (SDF-1)-binding receptor CXCR4. Here, we report that human rhabdomyosarcoma (RMS) cell lines secrete MIF and that this chemokine (a) induces phosphorylation of mitogen-activated protein kinase (MAPK) p42/44 and AKT, (b) stimulates RMS cell adhesion, (c) enhances tumor vascularization, but surprisingly (d) decreases recruitment of cancer-associated fibroblasts (CAF). Because RMS cells used in our studies do not express CXCR2 and CD74 receptors, the biological effects of MIF on RMS cells depend on its interaction with CXCR4, and as we report here for the first time, MIF may also engage another SDF-1-binding receptor (CXCR7) as well. Interestingly, downregulation of MIF in RMS cells inoculated into immunodeficient mice led to formation of larger tumors that displayed higher stromal cell support. Based on these observations, we postulate that MIF is an important autocrine/paracrine factor that stimulates both CXCR4 and CXCR7 receptors to enhance the adhesiveness of RMS cells. We also envision that when locally secreted by a growing tumor, MIF prevents responsiveness of RMS to chemoattractants secreted outside the growing tumor (e.g., SDF-1) and thereby prevents release of cells into the circulation. On the other hand, despite its obvious proangiopoietic effects, MIF inhibits in CXCR2/CD74-dependent manner recruitment of CAFs to the growing tumor. Our data indicate that therapeutic inhibition of MIF in RMS may accelerate metastasis and tumor growth.
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Affiliation(s)
- Maciej Tarnowski
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA
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Tarnowski M, Grymula K, Liu R, Tarnowska J, Drukala J, Ratajczak J, Mitchell RA, Ratajczak MZ, Kucia M. Macrophage migration inhibitory factor is secreted by rhabdomyosarcoma cells, modulates tumor metastasis by binding to CXCR4 and CXCR7 receptors and inhibits recruitment of cancer-associated fibroblasts. Mol Cancer Res 2010; 8:1328-43. [PMID: 20861157 DOI: 10.1158/1541-7786.mcr-10-0288] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The overexpression of macrophage migration inhibitory factor (MIF) has been observed in many tumors and is implicated in oncogenic transformation and tumor progression. MIF activates CXCR2 and CD74 receptors and, as recently reported, may also bind to the stromal-derived factor-1 (SDF-1)-binding receptor CXCR4. Here, we report that human rhabdomyosarcoma (RMS) cell lines secrete MIF and that this chemokine (a) induces phosphorylation of mitogen-activated protein kinase (MAPK) p42/44 and AKT, (b) stimulates RMS cell adhesion, (c) enhances tumor vascularization, but surprisingly (d) decreases recruitment of cancer-associated fibroblasts (CAF). Because RMS cells used in our studies do not express CXCR2 and CD74 receptors, the biological effects of MIF on RMS cells depend on its interaction with CXCR4, and as we report here for the first time, MIF may also engage another SDF-1-binding receptor (CXCR7) as well. Interestingly, downregulation of MIF in RMS cells inoculated into immunodeficient mice led to formation of larger tumors that displayed higher stromal cell support. Based on these observations, we postulate that MIF is an important autocrine/paracrine factor that stimulates both CXCR4 and CXCR7 receptors to enhance the adhesiveness of RMS cells. We also envision that when locally secreted by a growing tumor, MIF prevents responsiveness of RMS to chemoattractants secreted outside the growing tumor (e.g., SDF-1) and thereby prevents release of cells into the circulation. On the other hand, despite its obvious proangiopoietic effects, MIF inhibits in CXCR2/CD74-dependent manner recruitment of CAFs to the growing tumor. Our data indicate that therapeutic inhibition of MIF in RMS may accelerate metastasis and tumor growth.
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Affiliation(s)
- Maciej Tarnowski
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA
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Arush MWB, Kollender Y, Issakov J, Shalom RB, Arieh YB, Malkin L, Postovsky S. Unusual leptomeningeal dissemination in a child with extracranial metastatic alveolar rhabdomyosarcoma. Pediatr Hematol Oncol 2009; 26:473-8. [PMID: 19657999 DOI: 10.3109/08880010902993218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors describe a 6-year-old boy diagnosed with alveolar rhabdomyosarcoma located in the thigh, with distal metastases to lungs, bones, and bone marrow. A very good partial response to first-line chemotherapy was obtained, but the child developed fatal leptomeningeal dissemination immediately after complete resection of the primary tumor. This case demonstrates the rapidity with which leptomeningeal spread of extracranial metastatic alveolar rhabdomyosarcoma can occur and underscores the importance of diagnostic lumbar puncture and brain radiological investigations at diagnosis, even when the tumors are not in the parameningeal location.
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Affiliation(s)
- Myriam Weyl Ben Arush
- Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel. m
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Abstract
Myelofibrosis is a rare childhood myeloproliferative disorder. It has been reported as an associated complication of certain hematologic malignancies or as an isolated idiopathic process. We describe clinical course of 6 children diagnosed over 6 years. One child each responded well to steroid and treatment of the underlying condition. Three children died because of underlying conditions and 1 child was lost to follow up. A thorough search should be made for underlying disease when myelofibrosis is first diagnosed. Trephine biopsy though giving useful information, does not have a prognostic significance.
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