Embryonal rhabdomyosarcoma of the cervix presenting as a cervical polyp in a 16-year-old adolescent: a case report

Abstract

IntroductionEmbryonal rhabdomyosarcoma of the female genital tract is rare in the cervix. It has been mainly discussed in the context of individual case studies. It tends to occur in children and young women. Treatment ranges from radical surgery to conservative surgery, followed by chemotherapy.Case presentationA 16-year-old Moroccan adolescent girl presented to our center with a protruding mass from her vaginal introitus, as a polyp of 6cm. An examination revealed a polyp within her vagina, thought to be arising from her cervix and a polypectomy was performed. Microscopic findings are consistent with an embryonal rhabdomyosarcoma (botryoide type). A computed tomography of her thorax, abdomen and pelvis were performed and residual disease was found as a mass located at her cervix, which measured approximately 4.5cm in its widest dimensions, without evidence of metastatic disease. Due to the fact that she is young, after discussions in a multidisciplinary meeting, she was subsequently treated with four cycles of multi-agent chemotherapy. Two cycles of chemotherapy and radiotherapy were administered due to the lack of response, but she presented vaginal bleeding with persistence of the same mass in computed tomography. Hence a total interadnexal hysterectomy was made. A histologic examination found residual embryonal rhabdomyosarcoma (botryoide type) located in all her cervix and she is currently under chemotherapy.ConclusionsThe presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor that allows “fertility-sparing surgery” for these young patients.

Sarcoma botryoides in a 14 year old girl: a rare case

“…The decision for surgery was taken keeping in mind the poor patient profile likely to be lost to follow up. Literature too has stated a similar case of a 16 year old Moroccan girl 11 with sarcoma botryoides where the lesion persisted even after chemotherapy and subsequently she had to undergo surgery. The risk of recurrence of the disease, poor patient compliance and follow up, and the patient party consenting for surgery were the main factors which prompted us to take a surgical approach.…”

“…It typically occurs in young females and most commonly affected age group is between 12-26 years. 11,12 Clinically sarcoma botryoides can present as abnormal vaginal bleeding, prolapsing mass per vaginum or an abdominopelvic mass. Histological features include undifferentiated mesodermal and striated muscle cells with fibromyxomatous stroma and a distinct "cambium layer" beneath the epithelium which is characteristic of sarcoma botryoides.…”

Recurrent Cervical Sarcoma Botryoides in a 3-Year-Old Female: Approach in a Limited Resource Setting

“…Sarcoma botryoides may appear as abnormal vaginal bleeding, prolapsing mass through vagina, or abdominal-pelvic mass [4]. The major physical finding is the presence of a mass in the vagina.…”

Rhabdomyosarcoma of the Cervix, Local Excision or Radical Surgery (Report of Two Cases and Review of the Literature)

“…The risk of recurrence and metastatic spread, especially in patients treated with conservative approach, is a concern. Fertility-sparing surgery should not be considered with the presence of extensive uterine involvement or metastases (11). We suggest that, if negative surgical margin cannot be achieved with conservative surgery, radical hysterectomy should be performed.…”