Primary Rhabdomyosarcoma of the Pleura: A Case Report and Review of the Literature

Abstract

Rhabdomyosarcoma is a malignant tumor of striated muscle tissue that can exceptionally present in the pleura. Its prognosis is generally poor. We report a case of an eight-year-old child admitted for a persistent dry cough which had progressed for three weeks, complicated by breathing difficulties and a deterioration in general condition. He had a history of recent contact with an uncle with pulmonary tuberculosis. Clinical examination on admission revealed right pleural effusion syndrome with moderate respiratory repercussion. The biological assessment shows moderate inflammation and a very high level of lactate dehydrogenase (LDH). Radiologically, there was abundant right pleurisy with intra-pleural nodular masses without ipsilateral pulmonary invasion or other distant localization. Pleural puncture reveals exudative lymphocytic fluid with negative tuberculous polymerase chain reaction (PCR) and atypical cells in cytology. Biopsy of the pleural mass showed pleural rhabdomyosarcoma of the alveolar type. The pet scan found bone metastases at two costal arches. After conditioning, the child received several courses of chemotherapy. The clinical and radiological outcome was favorable. This case is reported in view of its rarity and originality. We conclude that early diagnosis and treatment greatly improves the prognosis of this aggressive tumor.

Malignant Pleural Effusion in Pediatrics: A Rare Presentation

“…It is also worth noting here that the first case, which was diagnosed as Hodgkin's lymphoma, presented solely because of a cough and fever that did not resolve spontaneously in three days, whereas the second case, diagnosed as lymphoma, came in as a second presentation due to failure of antibiotics. Moreover, another case report of an eight-year-old with a primary rhabdomyosarcoma of the pleura also presented with a progressive dry and painful cough for eight weeks [ 8 ]. A general examination of a child with MPE might show mild-to-moderate respiratory distress, cachexia, dyspnea, and anxiety due to pain, hypoxemia, or discomfort [ 9 ].…”

“…A missed systemic examination initially in both of our cases, which eventually showed hepatomegaly, could be of clinical importance. However, a similar case report mentioned that there was neither lymphadenopathy nor hepatosplenomegaly during systemic examination [ 8 ]. One of the primary investigations that are done when suspecting pleural effusion is a chest X-ray.…”

Clinicopathological features and prognosis of primary pulmonary rhabdomyosarcoma in middle-aged and elderly patients: a case report and literature review

“…[1][2][3] RMS usually develops in the head and neck (35%), urogenital system (21%), extremities (19%), and chest (7%). 4 The clinicopathological features and prognosis of 76 cases of RMS in middle-aged and elderly individuals aged !40 years were previously analyzed. Only two cases occurred in the lungs; 5 hence, primary pulmonary RMS (PPRMS) is rare in the middle-aged and elderly population, which has been defined as age !45 years in the latest categorization of the World Health Organization.…”

Clinicopathological Features And Prognosis of Primary Pulmonary Rhabdomyosarcoma In The Middle-Aged And Elderly: A Case Report And Literature Review

“…RMS is a malignant primitive mesenchymal tumor with skeletal muscle differentiation and it is the most common sarcoma in children, accounting for more than 50% of soft tissue sarcomas in those age groups, but less than 5% of sarcomas in adults [1][2][3]. RMS usually occurs in the head and neck (35%), the urogenital system (21%), the extremities (19%), and the chest (7%) [4]. The clinicopathological features and prognosis of 76 RMS cases in the middle-aged and elderly ≥40 years old were analyzed, of which only 2 cases occurred in the lung [5], hence on PPRMS in the middle-aged and elderly is rarer.…”