RHABDOMYOSARCOMA IN PEDIATRIC :

A case of -13 year old grl !"# al$eolar r#a%do&yosarco&a

Anitha Muliyani
1
, Ch. Hari Nawangsih
2
, Eddy Sudijanto
2
Radiology Departent !a"ulty o# Medi"ine Diponegoro $ni%ersity & Dr. 'ariadi (eneral Hospital
SEMARAN(

A%s"rac" .
I'"rod(c"o') Rha)doyosar"oa is the ost "oon so#t*tissue sar"oa in "hildhood,
representing +, o# all "hildhood "an"ers . -t is thought arising #ro priiti%e esen"hyal
"ells "oitted to s.eletal us"le di##erentiation and "an o""ur in a %ariety o# organs and
tissues, in"luding those that la". striated us"le./here are three su)groups o#
rha)doyosar"oa 0 e)ryonal 1+2*32,4, al%eolar 115*6+,4 and pleoorphi" 1+*12,4.
E)ryonal and al%eolar rha)doyosar"oas o""ur priarily in "hildren, and pleoorphi"
rha)doyosar"oa o""urs ostly in adults. Care#ul diagnosti" iaging o# potential disease
sites at the tie o# presentation is "ru"ial in assigning ris.*)ased therapy.

Case *rese'"a"o') A *17 year old girl presented with right lower leg rapidly growing
asses. 8ast edi"al history was unrear.a)le. !aily history is negati%e #or "an"er,
physi"al e9a nota)le #or non*tender right lower leg swelling and soe ne"roti" areas.
:iopsy results were al%eolar rha)doyosar"oa. Chest 9*ray and a)doinal ultrasound
results were no etastati" lesion. 8lain radiograph o# right lower leg showed so#t tissue ass
with poorly de#ined argins and lo"al )one in%asion o# the #i)ula with pereati%e pattern o#
)one destru"tion and interrupted periosteal rea"tion. !indings on ultisli"e C/ were
dilatation o# the soleus us"les with a poorly de#ined so#t tissue ass surrounding id and
distal #i)ula. /he #i)ula is eroded, shows tuor in%asion o# the adja"ent )one. A#ter
intra%enous "ontrast ediu adinistration, the tuor shows inhoogenous enhan"eent
representing ne"roti" areas. 8atient and parents re#used surgi"al treatent 1aputation4.
E9ternal radiation with Co)alt ;2, total dose ;2 (y, in 72 #ra"tion)

Dsc(sso') Diagnosis o# rha)doyosar"oa is )ased on ananesis, physi"al e9aination,
iaging and histopathology. Ananesis and physi"al e9aination o# this 17 year old girl lead
to alignan"y "ondition. :iopsy results were al%eolar rha)doyosar"oa. So#t tissue ass
with poorly de#ined argin is %isi)le on plain 9*ray wih erosion and destru"tion o# #i)ula.
/he odality o# "hoi"e #or diagnosis o# so#t tissue sar"oas is MR-. Sin"e no MR- is
a%aila)le in the #a"ility, there#ore this patient was sent to attend ultisli"e C/ #or e"aluation
o# the e9tent o# tuor. /his patient had radiation without surgi"al e9"ision )e"ause she and
her parents re#used surgi"al treatent. /he radiation responses were poor .

Co'cl(so') Al%eolar rha)doyosar"oa o""urs priarily in "hildren o# all ages, #re<uently
on the e9treities. =esion is o#ten present as rapidly growing asses. /his tuor "ontains
round or o%al "ells with priiti%e yo)lasti" #eatures. :y using MR-, the iages are ore
"lear to show "ontrast )etween tuor with adja"ent stru"tures, also pro%ides e9"ellent three*
diensional de#inition o# #as"ial planes. >hene%er MR- "annot )e per#ored, ultisli"e C/
"an )e used as alternati%e iaging in deterining tuor in%ol%eent o# us"le, )one, joints,
or neuro%as"ular stru"tures. Al%eolar rha)doyosar"oa is one o# high*grade tuors that
ore aggressi%e than the e)ryonal type. /reatent usually "onsists o# surgi"al e9"ision
and&or post operati%e "heoterapy and radiation.

'eywords 0 Rha)doyosar"oa, pediatri"
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1
8rogra 8endidi.an Do.ter Spesialis - Radiologi !a.ultas 'edo.teran $ni%ersitas
Diponegoro & RS$8. Dr. 'ariadi Searang
2
Hoe Sta## :agian Radiologi !a.ultas 'edo.teran $ni%ersitas Diponegoro & RS$8. Dr.
'ariadi Searang