Sarcoma botryoides of the uterine cervix: a case report

Botryoid rhabdomyosarcoma of the uterine cervix: Report case

Rhabdomyosarcoma of the cervix is among the rare histological types of cervical cancers, which are usually seen in young girls or women in the general active period. The usual circumstances of diagnosis are dominated by recurrent metrorrhagia. At the initial stage, the lesions may be asymptomatic or take on the appearance of a benign polyp. In the case reported here, the clinical symptomatology was recurrent metrorrhagia with a cervical implanted polyp occurring 28 months after resection of a benign polyp. RMS is one of the malignant tumors of mesenchymal origin. Typically, it is a malignant tumor proliferation of cells with morphological and/or phenotypic striated muscle differentiation. The characteristic cells of this tumor are rhabdomyoblasts rhabdomyosarcomas are classified into three histological subtypes: embryonal, alveolar, and anaplastic. Within embryonal RMS, it is possible to distinguish between botryoid, leiomyomatous and anaplastic forms. Botryoid and leiomyomatous forms are classically described as having a more favorable prognosis. Treatment is based on a multidisciplinary approach that includes indications for conservative surgery, chemotherapy, radiotherapy and brachytherapy.

Embryonic cervical rhabdomyosarcoma complicated with uterine inversion with cerebral venous sinus thrombosis as the first symptom: a case report and literature review

The probability of rhabdomyosarcoma occurring in the cervix is less than 0.5% and may be associated with a pathogenic dicer 1, ribonuclease III (DICER1) gene variation. Tumour-induced hypercoagulability and high levels of cancer antigen (CA) 125 are risk factors for cerebral venous sinus thrombosis (CVST). In addition, although nonpuerperal uterine inversion is very rare and is usually caused by leiomyomas from the uterus, large cervical masses can also be the cause. This case report describes a 24-year-old woman with uterine inversion caused by an embryonic cervical rhabdomyosarcoma that presented with CVST as her first symptom. The patient underwent laparoscopic total uterus and bilateral salpingectomy, during which the uterus was found to be completely inverted. Postoperative pathology confirmed embryonic cervical rhabdomyosarcoma. The patient quickly developed lung and para-aortic lymph node metastases. Two months later, the patient died of complications. When coagulation indices in patients with tumours are abnormal, especially when the levels of D-dimer and CA125 increase, it is recommended that anticoagulant therapy is administered in a timely manner to prevent the occurrence of CVST. Furthermore, for large cervical tumours, physicians should also be alert to the occurrence of uterine inversion.

[A rare cases of rhabdomyosarcoma of the uterine cervix: about a case and review of the literature]

Le rhabdomyosarcome du col utérin fait partie des types histologiques rares des cancers du col, qu'on observe généralement chez la jeune fille ou la femme en période d'activité générale. La stratégie thérapeutique se base sur l'association des trois modalités thérapeutiques (chimiothérapie-radiothérapie-chirurgie) vu l'agressivité de la maladie. Nous rapporterons ainsi un cas de rhabdomyosarcome du col utérin chez une fille de 20 ans. Il s'agit d'une patiente âgée de 20 ans, rapportant comme antécédents pathologique particulier la notion d'infection génitale à répétition. Le premier signe rapporté était des métrorragies abondantes avec à l'examen la présence d'une masse cervicale en grappe de raisin. La biopsie était en faveur d'un rhabdomyosarcome du col. Le bilan d'extension montrait une masse localement avancée sans métastase. La patiente a reçu 5 cures de VAC avec une régression du processus tumoral de 90%. Patiente fut opérée et a bénéficié d'une hystérectomie sans conservation des annexes. Puis elle a bénéficié d'une radiothérapie postopératoire sur le pelvis. Le recul était de 13 mois, la patiente est toujours en rémission complète. Le RMS du col utérin est une tumeur rare qui survit essentiellement chez la jeune fille. L'extension est surtout locorégionale. Le traitement consiste en un geste chirurgical allant d'un éventuel traitement conservateur jusqu'au traitement radical associé à une chimiothérapie péri-opératoire. La place de la radiothérapie demeure imprécise.

Botryoid Rhabdomyosarcoma of the Cervix: Case report with review of the literature

Botryoid rhabdomyosarcoma is an aggressive malignancy that arises from embryonal rhabdomyoblasts. It is commonly seen in the genital tract of female infants and young children. Due to the young age of affected patients, this malignancy poses a management challenge as the preservation of hormonal, sexual and reproductive function is essential. There is currently no consensus regarding management. However, treatment strategies for these tumours have evolved from radical exenterative surgeries to more conservative management options. We report a case of botryoid rhabdomyosarcoma in an adolescent girl presenting to Kasturba Hospital, in Manipal, India, in August 2007 with botryoid rhabdomyosarcoma of the cervix. She was treated with surgery and adjuvant chemotherapy. The patient remained healthy until eight months after the surgery. After acquiring a varicella zoster virus infection, she died due to septic shock and multiple organ failure. Awareness of such an uncommon lesion and its clinical implications is important to avoid misdiagnosis.

Embryonal rhabdomyosarcoma (botryoid type) of the uterine corpus and cervix in adult women: report of a case series and review of the literature

In its classical form, embryonal rhabdomyosarcoma (ERMS, botryoid type) is a vaginal neoplasm occurring in infants and young girls and is often not considered in the differential diagnosis of uterine corpus and cervical spindle cell tumors in adult women. Clinicopathologic and immunohistochemical features of 25 cases of ERMS in women 20 years of age or older were analyzed. Patient age ranged from 20 to 89 years (mean, 44.4 y; median, 46 y), with 8 patients aged 20 to 39 years, 14 patients aged 40 to 59 years, and 3 patients older than 60 years of age. Tumors originated in the cervix in 20 cases and in the uterine corpus in 5. They were characterized by an edematous hypocellular spindle cell proliferation, typically with cellular condensation beneath epithelial surfaces (cambium layer), in which tightly packed hypercellular foci were scattered. Neoplastic cells had hyperchromatic nuclei and minimal cytoplasm, usually with delicate cytoplasmic processes. Occasionally, elongated or globular cells with eosinophilic cytoplasm (rhabdomyoblasts) were evident, but cytoplasmic cross-striations were only rarely identified. Apoptotic bodies and mitotic figures were usually identified in the hypercellular foci. Hemorrhage was common, often making recognition of the hypercellular foci difficult. Desmin and myogenin were coexpressed in 22 of 23 (95.6%) tumors evaluated. Proliferative activity, as assessed by Ki-67 expression, was notably elevated in all tumors evaluated, typically concentrated in the hypercellular foci. Estrogen and progesterone receptors were expressed focally in only 3 of 12 (25%) and 1 of 8 (12.5%) tumors evaluated, respectively. Follow-up was available in 7 cases. Five patients were alive without evidence of disease with follow-up of 3 to 8 years, and 1 patient was alive with disease at 5 months. One patient died at 5 months with pulmonary nodules, but it was not determined whether this was due to metastatic ERMS or the patient's known ductal breast carcinoma. ERMS has a broader clinical profile than classically expected and should be considered in the differential diagnosis of a uterine corpus or cervical spindle cell tumor, regardless of patient age. Recognition can be rendered difficult by the hypocellular background, which can suggest a benign polyp or low-grade tumor, and hemorrhage, which can obscure the characteristic hypercellular foci. Identification of hypercellular foci in which mitotic activity and apoptotic bodies are found, desmin and myogenin are coexpressed, proliferative activity is notably elevated, and hormone receptor expression is usually absent is very useful for establishing the diagnosis.

[Sarcoma botryoïde of the uterine cervix: report of a case]

Botryoïde sarcoma of the uterine cervix is a very rare tumor of the young woman or during genial activity. Less than 100 cases have been reported in the literature. The treatment ranged from radical surgery to conservative surgery followed by chemotherapy. We report a case of cervical botryoide rhabdomyosarcoma occurred in a 33 year-old woman treated primary by chemotherapy followed by surgery and adjuvant chemotherapy. The patient died by extensive metastatic retroperitoneal nodes and lung.