Rhabdomyosarcoma of the oral cavity--report of eight cases

Embryonal Rhabdomyosarcoma of the Tongue in Adults

(1) Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. One third of cases appear in the head and neck, with 60% of these being embryonal type. RMS is extremely rare in adults, comprising only 1% of adult malignancies, and of those, only 3.3% are rhabdomyosarcomas. (2) Case report: A 46 y.o. male presented with a 1 cm exophytic pediculated painless lesion on the dorsum of his tongue, with progressive growth for 3 months. An excisional biopsy revealed an "embryonal rhabdomyosarcoma with fusocellular areas, with negative rearrangement for gen FOXO1A, negative MDM2 (only focal positivity), and positive INI-1". Subsequent contrast-enhanced MRI concluded the presence of a lesion with imprecise margins in the right half-tongue, 15 × 8 × 7 mm (longitudinal × transverse × craniocaudal), compatible with a sarcoma. The patient underwent a partial centrolingual glossectomy followed by reconstruction with a buccinator muscle local flap. After surgery, he received chemotherapy with eight cycles of VAC (vincristine, actinomycin, and cyclophosphamide) protocol. The patient is now disease free after 42 months, with good tongue function. (3) Discussion and conclusions: Embryonal RMS is an extremely rare sarcoma in adults, and the location in the tongue is even more exceptional (only two more similar cases are reported in the literature). The prognosis in adults is significantly poorer than in children. A complete margin-free resection with an adequate chemotherapy protocol is the treatment of choice in cases such as these.

Rhabdomyosarcoma of the oral cavity in children aged 0-2 years: A scoping review

BACKGROUND

The aim of this study was to collect, synthesize, and analyze the clinic-demographic data of rhabdomyosarcoma affecting the oral cavity of young children.

METHODS

The clinical question was "What are the clinical characteristics of oral rhabdomyosarcoma in children aged zero to two years?" Two independent reviewers selected the studies, extracted data, and assessed the methodological quality through the Joanna Briggs Institute Checklist. Descriptive statistics were performed in SPSS. (protocol: osf.io/b9hvy).

RESULTS

Thirty case reports with 41 patients were included (22 males; mean age at diagnosis: 15 months). All studies had some methodological limitations, mainly due to the lack of clarity for a final judgment. More than 70% of the cases affected the tongue or lips. Tumors had a fast growth (mean 2.5 months), usually with red coloration, and variable shape and consistency. Embryonal (63.41%) and alveolar (29.27%) were the most common histological subtypes. Treatment was quite variable but usually included surgery. Most patients (53.66%) were alive without disease at follow-up.

CONCLUSION

Oral rhabdomyosarcoma is rare in children aged 0-2 years without a marked gender predilection. The tumor presents as a fast and infiltrative growth leading to local and/or systemic symptoms, and a favorable prognosis for most patients.

Rhabdomyosarcoma of the maxillary gingiva

Rhabdomyosarcoma is a malignant skeletal muscle neoplasm. The tumor is much more common in children, and the most frequent site is head and neck region. Since this tumor is less frequent than other neoplasms in oral cavity, the clinicians sometimes ignore it, working the patients up. Rhabdomyosarcoma is a high-grade malignancy with poor prognosis. Considering the aggressive behavior and various clinical or histopathologic presentations of the tumor, early diagnosis has a significant impact on the treatment outcome and prognosis of the patients. We highlight the importance of combining the clinical, radiographic, and histopathologic examination to obtain a definitive diagnosis in sarcomas of the head and neck region, especially rhabdomyosarcoma. A case of rhabdomyosarcoma of the maxillary gingiva is presented in a 32-year-old woman in which the primary incisional biopsy was erroneously interpreted as an inflammatory process and consequently, the accurate diagnosis postponed for about 10 months.

Rhabdomyosarcoma of the tongue: report of a case and review of the literature

Rhabdomyosarcomas are the most common soft tissue tumors in children. Head and neck is one of the most frequently affected site. Within the nonparameningeal, nonorbital head and neck region, rhabdomyosarcomas of the tongue are very rare. We present a 2-year-old boy diagnosed with rhabdomyosarcoma of the tongue. The child was treated with complete surgical resection and chemotherapy. He is followed up with no evidence of disease 6 months after termination of therapy. The literature on rhabdomyosarcoma of the tongue is reviewed.

Rhabdomyosarcoma of the maxillary gingiva

BACKGROUND

Rhabdomyosarcoma is a malignant neoplasm of primitive mesenchyme exhibiting skeletal muscle differentiation. Oral rhabdomyosarcoma is rare and accounts for only 0.04% of all head and neck malignancies.

METHODS

A 33-year-old woman presented with an erythematous gingival mass involving the anterior maxillary gingiva. The lesion had been present for > or =13 months before presentation, and in recent months, it had become intermittently painful.

RESULTS

Clinical examination exhibited erythema and enlargement of the interdental papillae between the left maxillary canine, lateral incisor, and central incisor. The tissue was boggy and tender on palpation. Incisional biopsies were performed, and microscopic examination showed a cellular proliferation of spindle-shaped to ovoid cells with hyperchromatic, enlarged, and pleomorphic nuclei. Many of the tumor cells exhibited abundant eosinophilic cytoplasm. Immunohistochemical stains showed the tumor cells to be positive for desmin, myogenin, and myogenic differentiation 1 (MyoD1). A diagnosis of embryonal rhabdomyosarcoma was made. The patient was treated by surgical resection with postoperative chemotherapy and radiation. The patient had no evidence of disease at a follow-up examination 1 month after completion of therapy.

CONCLUSIONS

Oral rhabdomyosarcoma can develop insidiously. Pain is a variable presenting symptom, and early lesions may be mistaken for benign neoplastic, inflammatory, or infectious processes. Over several decades, a multidisciplinary treatment approach that includes surgical removal if resectable, in combination with multiagent chemotherapy and possibly radiation therapy, has improved survival rates.

Orofacial rhabdomyosarcoma in neonates and young children: a review of literature and management of four cases

Rhabdomyosarcoma (RMS) is an aggressive malignant skeletal muscle neoplasm arising from embryonal mesenchyme. It accounts for over 50% of all pediatric soft tissue sarcomas. The head and neck region is the most common site for this tumor in children. Neonatal presentation of this tumor is rare. We present the management of one neonatal case and three additional cases of orofacial RMS in children under the age of 7 years. All four patients were seen in the department of oral and maxillofacial surgery at Children's Hospital and Regional Medical Center (CHRMC) in Seattle between 1992-2000. Three of the four cases were alveolar RMS and one was botryoid sub-type of embryonal RMS. Three patients were treated with a combination of surgery, chemotherapy and radiation, while the patient with botryoid RMS was treated with surgery and chemotherapy only. The patient with congenital RMS died at 2.5 years of age due to recurrent metastatic disease. The other three patients are alive without evidence of recurrent with a mean follow up was 5.5 years (range 2.5-8.5 years). We discuss the current management, diagnosis, biological behavior, histopathology, prognosis and survival of head and neck RMS in neonates and young children.