Cutaneous metastasis of rhabdomyosarcoma

Abstract

EditorCutaneous metastases represent an opportunity to detect a potentially treatable neoplasm before other evidence of it is present. The relative frequency of skin metastases is similar to that of primary tumours. The most frequent in women are breast, colon and melanoma and in men, lung, colon and melanoma. 1 Rhabdomyosarcoma is a soft tissue neoplasm, extremely rare in adults. It is an aggressive tumour with high probability of distant metastasis and poor prognosis with a 5-year survival rate of less than 50%. 1-3A 34-year-old female patient, with no medical history of known diseases, presented with a 6-month evolution of right omalgia, severe, gravative headache of sudden onset, dizziness and starbursts and subsequent gait disorder with lateropulsion and temporal haemianopsia on the right side.She was referred to the department of Dermatology as she presented an haemorrhagic subungueal crusted lesion, with an emerging 1-week evolution epidermal collarette on the right ring finger; and a hard 1-cm nodule on the tip of the right index finger, with slightly erythematous overlying skin (Fig. 1a,b), from which a biopsy was performed.A brain CT scan and MRI with contrast revealed a heterogeneous lesion, with mass effect in the cerebellum, and a lesion on the left occipital lobe, showing perilesional oedema, both suggestive of metastases.The histological examination of the skin sample showed: skin covered with stratified squamous epithelium; dermis with mesenchymal tumour cell infiltrate, formed by intertwining fascicles of atypical fusiform cells, with hyperchromatic nuclei, some with vesicular nuclei, with evident nucleoli and eosinophilic cytoplasm. Scarce tumour stroma, fibrous, with lymphocytic infiltrate. Frequent mitotic figures, some of them atypical. Absence of tumour necrosis. Conclusion: fusiform cell sarcoma grade 2, histological grade, tumour differentiation score 3, mitosis score 1 (Fig. 2a-c). Immunohistochemical study revealed that neoplastic cells were positive for vimentin, desmin, myoglobin and actin, and negative for S100 protein and CD68. Diagnosis: Rhabdomyosarcoma.The abdominal-pelvic CT scan was normal, and a thoracic CT scan showing a large solid lesion in the soft tissues of the right dorsal region, involving the shoulder blade and causing oste olisis, perilesional adenopathy, a nodular lesion in the right upper lobe and a nodular lesion in the right pulmonary hilum.Upon diagnosis of rhabdomyosarcoma with distant metastatic disease, the department of Oncology decided to start treatment with holocraneal radiotherapy to reduce the neurological symptomatology, and chemotherapy with Adriamycin, Ifosfamide and Mesna. The patient died after 2 months of starting with the treatment.Rhabdomyosarcoma is a solid neoplasm, and it constitutes approximately 50% of all the soft tissues neoplasms in children. Adults are rarely affected with two peaks of incidence: young adults and the elderly. 2,4The most common anatomic sites of occurrence are, in order of frequency, the head and neck, the genitourinary ...