Primary Rhabdomyosarcoma of the Breast: Imaging Findings and Literature Review

Imaging Insights Suggesting a Sinister Cause of a Breast Mass in Adolescents: A Case of Rhabdomyosarcoma in a Teenager

Background

Sarcomas of the breast are exceedingly rare, accounting for less than 1% of malignant breast tumors, with primary rhabdomyosarcomas being even rarer. Due to the scarcity of reported cases, the imaging characteristics of breast rhabdomyosarcoma are not well-defined, making diagnosis challenging, especially in adolescents.

Case description

We present the case of a 17-year-old female diagnosed with embryonal rhabdomyosarcoma following a comprehensive workup for right breast masses. Initial imaging showed no distant metastasis, and the patient underwent a right mastectomy followed by adjuvant chemoradiotherapy. A few months post-treatment, she developed recurrent nodules in the chest wall. Further investigation confirmed the recurrence of embryonal rhabdomyosarcoma.

Conclusions

This case underscores the importance of considering primary rhabdomyosarcoma as a differential diagnosis in adolescent breast lesions. Given its rare occurrence and potential imaging overlap with more common tumors like cystosarcoma phyllodes, awareness and careful evaluation are critical for accurate diagnosis and timely management.

LEARNING POINTS

Critical imaging insights: The report provides valuable imaging characteristics that can help differentiate rhabdomyosarcoma from more common breast tumors like fibroadenoma and cystosarcoma phyllodes, resulting in more accurate and timely diagnosis.

Primary breast rhabdomyosarcoma in a 17-year-old girl

ABSTRACT

Primary rhabdomyosarcoma (RMS) of breast is a very rare malignancy usually affecting adolescent girls with a poor prognosis and no definitive treatment established. Here, we report a case of a 17-year-old girl who presented to us operated for a right breast mass with histopathology suggestive of RMS. She had undergone wide local excision with nipple-areola complex along with axillary node dissection for positive nodes. Immunohistochemistry was done which showed tumor cells which were positive for desmin and myogenin and were negative for leukocyte common antigen, cluster of differentiation 34 (CD-34), and AE1/AE3 which confirmed the diagnosis of RMS. She was planned for adjuvant chemotherapy but refused taking treatment. Two months later, she presented with local site recurrence for which re-excision was done, and she was started on adjuvant chemotherapy with vincristine, Adriamycin, and cyclophosphamide regimen after metastatic workup. She then received radiation treatment following which she is at present under follow-up with no signs of disease until now.

Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Turning the Magnifying Glass on Rare and Aggressive Entities

Breast sarcomas (BSs), phyllodes tumors (PTs), and desmoid tumors (DTs) are rare entities that arise from connective tissue. BSs can be classified as either primary or secondary, whether they develop de novo or after radiation exposure or lymphedema. PIK3CA seems to play an important common role in different BS. Malignant PTs show similar behavior to BSs, while DTs are locally aggressive but rarely metastasize. BSs usually present as unilateral, painless, rapidly growing masses with rare nodal involvement. The diagnosis should be based on magnetic resonance imaging and a core needle biopsy. Staging should comprise a chest computed tomography (CT) scan (except for benign PT and DT), while abdominal and pelvic CT scans and bone scans should be added in certain subtypes. The mainstay of treatment for localized BS is surgery, with margin goals that vary according to subtype. Radiotherapy and chemotherapy can be used as neoadjuvant or adjuvant approaches, but their use in these settings is not standard. Advanced BS should be treated with systemic therapy, consistent with recommendations for advanced soft tissue sarcomas of other topographies. Given the rarity and heterogeneity of these entities, multidisciplinary and multi-institutional collaboration and treatment at reference centers are critical.

Recurrent malignant phyllodes tumor of the breast: An extremely rare case of recurrence with only rhabdomyosarcoma components

Rhabdomyosarcoma is a rare disease that typically occurs in children. Rhabdomyosarcoma seldom occurs in the breast, and its diagnosis and treatment have infrequently been reported. The present case is a rare one of a recurrent malignant phyllodes tumor of the breast with only rhabdomyosarcoma components. A 69-year-old woman received a diagnosis of borderline phyllodes tumor of the left breast and underwent partial mastectomy. During follow-up, a left breast mass was found 1 year and 8 months after the previous surgery. Based on examination findings, it was suspected to be recurrent phyllodes tumor, so total left mastectomy was performed in our hospital. After the surgery, immunostaining failed to determine the epithelial component which may be produced by the proliferative part of stromal cells of previous phyllodes tumors. However, we could not exclude the possibility that this was a new tumor. After comparing samples with specimens from the first operation, it was finally determined to be a malignant phyllodes tumor with a rhabdomyosarcoma component. Therefore, chemotherapy was given, and vincristine, actinomycin D, and cyclophosphamide therapy was introduced. At the same time, radiation therapy was planned. Among phyllodes tumors, cases involving rhabdomyosarcoma components are very rare, especially those where the recurrence morphology only shows the same rhabdomyosarcoma components. This was a rare case with unique characteristics and great reference value.

Metastatic embryonal rhabdomyosarcoma of the breast: A case report and literature review

Rhabdomyosarcoma (RMS) is a common malignancy in children, but embryonal rhabdomyosarcoma (ERMS) deposits rarely occur in the breast in adults. Therefore, little is known about magnetic resonance imaging (MRI) features of breast metastases from RMS, especially the embryonal type. We reported a case of a 22-year-old woman who was diagnosed with ERMS at left foot 2 years ago and accepted operation and chemotherapy. She was confirmed to have breast metastases from the left foot. Successive imaging examinations were performed 3 months apart. Breast ultrasound indicated a benign lesion, and further examination did not reveal any bone metastases. However, predominant restricted diffusion and rim contrast enhancement on MRI combined with the patient's medical history suggested a malignancy of BI-RADS 5. After 3 months, breast ultrasound revealed masses detected last time became larger and lobulated. In addition, internal heterogeneous intensity and rim contrast enhancement with restricted diffusion were revealed on MRI. We speculated that typical MRI findings of breast metastases from RMS may include iso- to hypointensity on T1WI, heterogeneous hyperintensity on T2WI, and circular enhancement with restricted diffusion. Moreover, mild peritumoral edema, rapid expansion of necrosis, and ascending time-intensity curve detected on MRI may be features of the ERMS type.

Evaluation of clinical efficacy of Chemotherapy for Rhabdomyosarcoma in children

OBJECTIVE

To investigate the clinical characteristics and treatment methods of rhabdomyosarcoma in children and the efficacy of the methods.

METHODS

The clinical data of 30 children with rhabdomyosarcoma who were admitted to our hospital from August 2013 to August 2017 were retrospectively analyzed. The clinical characteristics were summarized, and the curative effect and prognosis were evaluated.

RESULTS

Among all the children (N=30), there were 20 males and 10 females, with a median age of 3.5 years. As to the primary site, there were 13 cases of head and neck, 11 cases of trunk, three cases of urogenital system and three cases of limbs. There were 25 cases of embryonic type, 4 cases of alveolar type and one case of polymorphic type. As regards clinical stage, there were one case of stage I, 9 cases of stage II, 13 cases of stage III and 7 cases of stage IV. There were one case of low risk, 19 cases of medium risk and 10 cases of high risk. Eight cases received surgery alone, 22 cases received combined treatment of surgery and chemotherapy (the chemotherapeutics followed three schemes, low-risk group (VAC+VA), moderate risk group (VAC) and high risk group (alternating use of VDC and IE). Among all the cases (N=30), there were 14 cases of complete remission (CR), five cases of partial remission (PR), four cases of stable disease (SD), and 7 cases of progressive disease (PD). The CR rate was (N=14, 46.7%). The three-year overall survival (OS) rate was (N=19, 63.3%). The clinical efficacy and prognosis of children receiving surgery and chemotherapy were better than those of children receiving surgery alone, and the difference was statistically significant (P<0.05).

CONCLUSION

Rhabdomyosarcoma in children frequently happens in the head, neck and trunk. Embryonic type is the main pathological type of rhabdomyosarcoma. Comprehensive and standardized treatment based on surgery and chemotherapy is an important way to improve the curative effect in the treatment of rhabdomyosarcoma in children.

Primary Rhabdomyosarcoma of the Breast: Study of Three Cases at One Institution with a Review of Primary Breast Sarcomas

BACKGROUND

Primary breast sarcoma (PBS) is rare, comprising approximately 1% of breast malignancies. Rhabdomyosarcoma (RMS) accounts for an extremely small proportion of PBSs, often leading to delayed histologic confirmation.

METHODS

Upon reviewing Asan Medical Center's pathology database between 2000 and 2018, 41 PBS cases were retrieved, including three cases of primary RMS of the breast. Their clinicopathological features were analyzed, and the literature related to PBS and primary RMS of the breast was reviewed.

RESULTS

We identified three primary breast RMS cases from our institution database, comprising 7.3% of PBS: one case each of spindle cell/sclerosing RMS (ssRMS), alveolar RMS (aRMS), and embryonal RMS (eRMS). All cases involved adolescents or young adults (14, 16, and 25 years, respectively) who underwent mastectomy or radiotherapy and were confirmed using immunohistochemical testing for myogenin, desmin, and myogenic differentiation. The ssRMS patient experienced recurrence at the operation site 4 months post-surgery despite undergoing concurrent chemoradiotherapy. The aRMS patient had multiple metastases at diagnosis and showed FAX3-FOXO1 fusion transcripts; she died 22 months after the diagnosis. The eRMS patient had enlarged axillary lymph nodes; post-radiotherapy, the lesion recurred as multiple metastases to the bone and lung. She died 18 months post-diagnosis.

CONCLUSIONS

Our experience on RMS cases suggests that spindle cell or small round cell malignancy in breasts of young female should raise suspicion for the possibility of primary or secondary RMS. To our knowledge, this is the second report of primary breast ssRMS and it may help clinicians who encounter this rare disease in the future.

Primary Alveolar Rhabdomyosarcoma of the Breast in an Adult: An Extremely Rare Case

Sarcomas of the breast constitute less than 1% of all malignant breast tumors and primary rhabdomyosarcoma (RMS) is a very rare entity with limited case reports in the literature. RMS is common in children and adolescents and rare in adults. Primary RMS arising from the breast is exceedingly rare in adults. We report a case of a primary RMS of the breast in a 60-year-old woman, who presented in an early stage, mimicking invasive ductal carcinoma clinically and is in complete remission after three years of diagnosis and one year of treatment.