Cutaneous extrarenal rhabdoid tumor with myogenic differentiation

Malignant rhabdoid tumor of the musk gland and systemic T-cell lymphoma in a masked palm civet (Paguma larvata)

A 21-year-old male masked palm civet died after 2 months of continuous abdominal distention and poor appetite. Grossly, both musk glands were markedly swelled. Microscopically, round, polygonal and spindle neoplastic cells proliferated diffusely in the right musk gland and a metastatic focus was observed in the lung. The neoplastic cells had abundant cytoplasm with faintly eosinophilic inclusions that ultrastructurally corresponded to whorl aggregates of intermediate filaments. Immunohistochemically, these cells were positive for vimentin, cytokeratins and glial fibrillary acidic protein and negative for desmin. Based on these findings, the tumor was diagnosed as malignant rhabdoid tumor. Papillary adenoma was seen in the opposite musk gland. T-cell lymphoma of the lymph nodes, small intestine and liver was considered as the cause of death.

Utility of transmission electron microscopy in small round cell tumors

Small round cell tumors (SRCTs) are a heterogeneous group of neoplasms composed of small, primitive, and undifferentiated cells sharing similar histology under light microscopy. SRCTs include Ewing sarcoma/peripheral neuroectodermal tumor family tumors, neuroblastoma, desmoplastic SRCT, rhabdomyosarcoma, poorly differentiated round cell synovial sarcoma, mesenchymal chondrosarcoma, small cell osteosarcoma, small cell malignant peripheral nerve sheath tumor, and small cell schwannoma. Non-Hodgkin's malignant lymphoma, myeloid sarcoma, malignant melanoma, and gastrointestinal stromal tumor may also present as SRCT. The current shift towards immunohistochemistry and cytogenetic molecular techniques for SRCT may be inappropriate because of antigenic overlapping or inconclusive molecular results due to the lack of differentiation of primitive cells and unavailable genetic service or limited moleculocytogenetic experience. Although usage has declined, electron microscopy (EM) remains very useful and shows salient features for the diagnosis of SRCTs. Although EM is not always required, it provides reliability and validity in the diagnosis of SRCT. Here, the ultrastructural characteristics of SRCTs are reviewed and we suggest that EM would be utilized as one of the reliable modalities for the diagnosis of undifferentiated and poorly differentiated SRCTs.

Cutaneous Pleomorphic Rhabdomyosarcoma Occurring on Sun-Damaged Skin: A Case Report

Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor with skeletal muscle differentiation that can rarely present as a primary cutaneous tumor. There are 3 main subtypes of RMS: embryonal, alveolar, and pleomorphic. Primary cutaneous pleomorphic RMS is extremely rare, there being only 9 reported cases in the literature, 2 of which are radiation induced. We present a case of primary pleomorphic RMS occurring on the sun-damaged skin of the face of an 89-year-old woman. The tumor was diagnosed by histology, immunohistochemistry, and electron microscopy. The patient was treated by surgery and adjuvant radiotherapy. The tumor recurred rapidly after surgical excision. She died 2 months after the diagnosis from complications of treatment, local symptoms of tumor, and concurrent illnesses. Primary cutaneous pleomorphic RMS is a rare tumor of adults and pursues an aggressive clinical course.

Primary cutaneous rhabdomyosarcoma: a clinicopathologic review of 11 cases

BACKGROUND

Rhabdomyosarcoma is a malignant mesenchymal tumor with skeletal muscle differentiation. Primary cutaneous rhabdomyosarcoma is rare. We report a series of 11 cases of primary cutaneous rhabdomyosarcoma.

METHODS

Cases diagnosed as rhabdomyosarcoma arising in the dermis/subcutis with no identified primary tumor elsewhere were retrospectively reviewed. Follow-up was obtained.

RESULTS

The tumors occurred in five children and six adults. The adult subset consisted of pleomorphic, epithelioid and not otherwise specified (NOS) subtypes while the pediatric subset showed alveolar and embryonal subtypes. All cases showed immunohistochemical staining consistent with the diagnosis of rhabdomyosarcoma. Three adult cases showed immunoreactivity for cytokeratins (one pleomorphic, one epithelioid and one NOS.

CONCLUSIONS

Primary cutaneous rhabdomyosarcoma shows a bimodal age distribution and male predominance, correlating with rhabdomyosarcoma in deep soft tissue. Follow-up, available on all patients, showed aggressive behavior in both children and adults. Primary cutaneous rhabdomyosarcoma should be considered in the differential diagnosis of tumors with abundant eosinophilic cytoplasm and those with "small round blue cell" morphology. Desmin, myogenin and MYOD1 are a trio of markers with high sensitivity and specificity for primary cutaneous rhabdomyosarcoma. Cytokeratin immunoreactivity in primary cutaneous rhabdomyosarcoma represents a potential diagnostic pitfall in the differential diagnosis with sarcomatoid carcinoma.

Rhabdomyosarcoma of the skin resembling carcinosarcoma: report of a case and literature review

Rhabdomyosarcomas (RMSs) are soft tissue sarcomas with skeletal muscle differentiation. Cutaneous RMSs are exceedingly rare, and in most cases, they represent metastatic disease or the dermal involvement by a tumor arising in the underlying soft tissues. We herein report the case of a 41-year-old man who developed a cutaneous swelling of the right nasal orbital angle. An initial incisional biopsy showed cytokeratin-positive atypical spindle cells forming long and intersecting fascicles, thus the case was diagnosed as carcinosarcoma. In the subsequent excisional biopsy, the skeletal myogenic differentiation of the tumor cells infiltrating the dermis and subcutis was demonstrated by morphology (presence of rhabdomyoblasts), immunohistochemistry (positivity for desmin, myogenin, myoglobin, and actins), and electron microscopy (evidence of rudimentary sarcomeric structures). A final diagnosis of primary cutaneous RMS was made. The patient was subjected to postoperative radiation and chemotherapy, but after 4 months, the patient developed a tumor recurrence followed by distant metastases and death. Review of the literature reveals that RMSs of the skin are often underrecognized and display peculiar clinical features in comparison with their more common soft tissue counterpart.

Cutaneous rhabdoid tumor in a cat

Rhabdoid tumor is a highly aggressive neoplasm of unknown cellular origin in humans, usually occurring in the kidney and central nervous system of infants or children. In older patients, it occurs rarely in other organs, including the skin and soft tissues. A subcutaneous mass in a 13-year-old male mixed-breed cat was composed of nests or sheets of round to polygonal cells with glassy eosinophilic cytoplasmic inclusions. Immunohistochemically, many neoplastic cells expressed vimentin, localized to the cytoplasmic inclusions, whereas the cytoplasm of some neoplastic cells was diffusely positive for neuron-specific enolase, neurofilament, or S-100 protein. By electron microscopy, the cytoplasmic inclusions were found to be composed of aggregates of intermediate filaments. These findings are quite similar to the histologic, immunohistochemical, and ultrastructural features of human rhabdoid tumors and the few rhabdoid tumors reported in animals.