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Submitted
August 6, 2019
Accepted
July 21, 2020
Published
August 31, 2020
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Abstract

Rhabdomyosarcomas are the most common pediatric soft tissue sarcomas. However, rhabdomyosarcoma cases that manifest as a systemic disease or showing diffuse metastasis in the bone marrow are sporadic. The most common sites of metastasis due to rhabdomyosarcoma include lungs, lymph nodes, and bone marrow. The bone marrow involvement is seen in about 30% of cases of metastasis. We report a case of a 2-year-old boy with complaints of right eye protrusion. The result of a head CT-scan arouses suspicion of rhabdomyosarcoma. On physical examination, protrusion of the eye and swelling of the neck with a fixed and flat surface were observed. Peripheral blood examination resulted in pancytopenia (hemoglobin: 4 g/dL, leukocytes: 3,490 cells/µL, platelets: 16,000 cells/µL). The peripheral blood morphologies showed lymphoblasts and myeloblasts, whereas the bone marrow biopsy result showed infiltration of tumour cells (rosette cell form). Chest imaging examination showed suspected of skeletal metastases in bilateral scapulae and bilateral costae. Pancytopenia with tumour cells metastasis to the bone marrow was found in this case. Diagnosis of rhabdomyosarcoma with multiorgan metastasis and the presence of tumour cells in the bone marrow was based on clinical features, physical examination, laboratory examinations, and other supporting investigations.

Keywords

rhabdomyosarcoma metastasis rosette-forming cells

Article Details

How to Cite
Ratnaningsih, T., & Hurimah, W. (2020). Rhabdomyosarcoma metastases to the bone marrow of a 2-year-old male patient: A case report. JKKI : Jurnal Kedokteran Dan Kesehatan Indonesia, 11(2), 198–203. https://doi.org/10.20885/JKKI.Vol11.Iss2.art13
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References

  1. Diaconescu S, Burlea M, Miron I, Aprodu SG, Mihaila D, Olaru C, et al. Childhood rhabdomyosarcoma. Anatomo-clinical and therapeutic study on 25 cases. Surgical implications. Rom J Morphol Embryol. 2013;54(3):531–7.
  2. Goldblum JR, Folpe AL, Weiss SW. Enzinger and Weiss’s Soft Tissue Tumor - 5th edition. Saunders. 2008. 595–632 p.
  3. Breneman JC, Lyden E, Pappo AS, Link MP, Anderson JR, Parham DM, et al. Prognostic factors and clinical outcomes in children and adolescents with metastatic rhabdomyosarcoma-a report from the intergroup rhabdomyosarcoma study IV. J Clin Oncol. 2003 Jan;21(1):78–84.
  4. Bien E, MacIejka-Kapuscinska L, Niedzwiecki M, Stefanowicz J, Szolkiewicz A, Krawczyk M, et al. Childhood rhabdomyosarcoma metastatic to bone marrow presenting with disseminated intravascular coagulation and acute tumour lysis syndrome: Review of the literature apropos of two cases. Vol. 27, Clinical and Experimental Metastasis. 2010. p. 399–407.
  5. Khanna R, Nayak DM. Rhabdomyosarcoma with Bone Marrow Infiltration: A Diagnostic Dilemma. Internet J Oncol. 2012 Jun;8(2).
  6. Freling NJM, Merks JHM, Saeed P, Balm AJM, Bras J, Pieters BR, et al. Imaging findings in craniofacial childhood rhabdomyosarcoma. Vol. 40, Pediatric Radiology. 2010. p. 1723–38.
  7. Jawad N, McHugh K. The clinical and radiologic features of paediatric rhabdomyosarcoma. Vol. 49, Pediatric radiology. NLM (Medline); 2019. p. 1516–23.
  8. McDowell HP. Update on childhood rhabdomyosarcoma. Arch Dis Child. 2003;88(4):354–7.
  9. Hicks J, Flaitz C. Rhabdomyosarcoma of the head and neck in children. Oral Oncol [Internet]. 2002 Jul;38(5):450–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1368837501001051
  10. Oberlin O, Rey A, Lyden E, Bisogno G, Stevens MCG, Meyer WH, et al. Prognostic factors in metastatic rhabdomyosarcomas: Results of a pooled analysis from United States and European Cooperative Groups. J Clin Oncol. 2008;26(14):2384–9.
  11. Malempati S, Hawkins DS. Rhabdomyosarcoma: Review of the Children’s Oncology Group (COG) soft-tissue Sarcoma committee experience and rationale for current COG studies. Vol. 59, Pediatric Blood and Cancer. 2012. p. 5–10.
  12. Rodeberg DA, Garcia-Henriquez N, Lyden ER, Davicioni E, Parham DM, Skapek SX, et al. Prognostic significance and tumor biology of regional lymph node disease in patients with rhabdomyosarcoma: A report from the children’s oncology group. J Clin Oncol. 2011 Apr;29(10):1304–11.
  13. Meza JL, Anderson J, Pappo AS, Meyer WH. Analysis of prognostic factors in patients with nonmetastatic rhabdomyosarcoma treated on intergroup rhabdomyosarcoma studies III and IV: The children’s oncology group. J Clin Oncol. 2006;24(24):3844–51.
  14. Imataki O, Uemura M, Uchida S, Yokokura S, Takeuchi A, Ishikawa R, et al. Complete mimicry: A case of alveolar rhabdomyosarcoma masquerading as acute leukemia. Diagn Pathol. 2017;12(1):1–7.
  15. Maywald O, Metzgeroth G, Schoch C, Ludwig WD, Neff W, Hehlmann R, et al. Alveolar rhabdomyosarcoma with bone marrow infiltration mimicking haematological neoplasia. Br J Haematol. 2002;119(3):583.
  16. Demircioglu S, Ekinci O, Dogan A, Bayram I, Demir C. Bone marrow metastasis of alveolar rhabdomyosarcoma mimicking Burkitt’s lymphoma. Med Sci | Int Med J. 2018;946.