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Paranasal Sinus Embryonal Rhabdomyosarcoma Metastasizing to Breast and Ovary on PET/CT—A Case Report with the Review of Literature
CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(05): 454-458
DOI: DOI: 10.1055/s-0043-1768179
Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor of skeletal muscle origin. The head and neck, urinary tract, and extremities are the common sites of origin. Embryonal, alveolar, pleomorphic, and spindle/sclerosing are subtypes. It is more common in childhood and rare among adults. The incidence and risk factors for this disease are mainly largely unknown. RMS is sporadic in most instances; however, it is attributed to familial syndromes in some situations—its metastasis to the lungs, bone marrow, and lymph nodes. Breast and ovary involvement is scarce. Diagnostic workup mainly includes contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). However, 18F-fluro-deoxyglucose positron emission tomography (18F-FDG-PET/CT) and PET/MRI are increasing contribution to providing functional insights about tumor biology and improving the diagnostic accuracy of the imaging workup. This report presents a case of the neck's embryonal RMS metastasizing simultaneously to the breast and ovary. PET/CT imaging revealed the unusual pattern, further validated by histopathology.
Keywords
embryonal rhabdomyosarcoma - metastasis - breast - ovary
Declaration of Patient Consent
The patient gave written consent; in the form the patient consents to have images and clinical information published. The patient acknowledges that his or her name or initials will not be publicized.
Publication History
Article published online:
28 April 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
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Abstract
Rhabdomyosarcoma (RMS) is a malignant soft tissue tumor of skeletal muscle origin. The head and neck, urinary tract, and extremities are the common sites of origin. Embryonal, alveolar, pleomorphic, and spindle/sclerosing are subtypes. It is more common in childhood and rare among adults. The incidence and risk factors for this disease are mainly largely unknown. RMS is sporadic in most instances; however, it is attributed to familial syndromes in some situations—its metastasis to the lungs, bone marrow, and lymph nodes. Breast and ovary involvement is scarce. Diagnostic workup mainly includes contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). However, 18F-fluro-deoxyglucose positron emission tomography (18F-FDG-PET/CT) and PET/MRI are increasing contribution to providing functional insights about tumor biology and improving the diagnostic accuracy of the imaging workup. This report presents a case of the neck's embryonal RMS metastasizing simultaneously to the breast and ovary. PET/CT imaging revealed the unusual pattern, further validated by histopathology.
Keywords
embryonal rhabdomyosarcoma - metastasis - breast - ovary
Introduction
Rhabdomyosarcoma (RMS) is designated as the most frequently reported soft tissue sarcoma in children, accounting for more than 50%- of soft tissue sarcomas. RMS can appear at any age, although 87%- of patients present at an age younger than 15 years. It rarely affects adults.[1] Less than 1%- of all malignancies are soft tissue sarcomas, and 3%- of all soft tissue sarcomas are RMS.[2] It affects 4.3 cases per one million under 20 years of age annually.[2] RMS cells resemble skeletal muscle progenitor cells despite being derived from nonskeletal tissues.[3] RMS is divided into four clinical categories based on its histopathology—embryonal RMS (ERMS), alveolar RMS (ARMS), pleomorphic RMS (PRMS), and spindle cell and sclerosing RMS. ERMS accounts for most cases and has a favorable prognosis, but ARMS is clinically aggressive due to a propensity for metastasis and recurrence.[4] ERMS and ARMS are the most common histologies in children, but PRMS is nearly exclusively seen in adults. Furthermore, PRMS is more resistant to chemotherapy than ERMS and ARMS. RMS in older patients is associated with a poorer prognosis than in younger patients. They present with the primary tumor unfavorable and a more aggressive histologic subtype. Although the etiology and specific risk factors for RMS are unknown, in utero radiation exposure, faster in utero growth, low socioeconomic background, and parents who use recreational drugs during pregnancy all augment the chance of RMS. It usually presents as an isolated disease but has been linked to certain familial syndromes, including neurofibromatosis type I, Noonan syndrome, Li-Fraumeni syndrome (p53 mutations), Beckwith-Wiedemann syndrome, and Costello syndrome (HRAS mutations).[5]
The location of the initial tumor, age at presentation, and metastatic disease influence the presenting signs and symptoms. The head and neck region, the genitourinary tract, and the extremities are common sites for origin. The tumor may originate in the orbit, para meningeal sites (middle ear, nasal cavity, paranasal sinuses, nasopharynx, infratemporal fossa), and other sites (scalp, parotid gland, oral cavity, pharynx, thyroid, and parathyroid glands). These tumors are most commonly ERMS and rarely spread to regional lymph nodes.[6] Genitourinary tract RMS mainly arises in the prostate and bladder. They present as hematuria, urinary tract infection, and features of obstruction. In females, the vagina, cervix, and uterus are common sites. Vaginal RMS mainly presents as bleeding or discharge per vaginum and is more common at a younger age, whereas uterine and cervical RMS is more common in older females.[7] The third most prevalent site of RMS is the extremities. These tumors usually appear as a painful lump or swelling with or without erythema of the surrounding skin in adolescents. The ARMS subtype accounts for about half of all extremities RMS.[6] The trunk, intrathoracic area, perineal–perianal region, and biliary system are less common sites. RMS most frequently metastasizes to the lung, followed by bone, bone marrow, and lymph nodes. Usually, 25%- of the patients present with metastatic disease at the time of diagnosis. Visceral organ metastases are rare. There have been reports of primary RMS in the liver, brain, trachea, heart, and breast.[8]
Case Presentation
A 20-year-old female patient presented with a complaint of pain and swelling over the right side of the neck for 2 months. It was insidious in onset and progressively increased in size. She had swelling and bulging of the right eye and a diminution of vision for 1 month. On examination, she had multiple enlarged conglomerated lymph nodes over the right upper side of the neck and extending up to the posterior triangle of the neck. Contrast-enhanced computed tomography (CECT) of the head and neck was suggestive of a large, necrotic soft tissue mass lesion in the right maxillary, ethmoid, and sphenoid sinuses. It extended into the nasal cavity with the maxilla and cribriform plate erosion, and multiple cervical lymph nodes were also noted. Lymph node biopsy suggested ERMS. Immunohistochemistry (IHC) revealed tumor cells were positive for vimentin, desmin, Myogenin, and CD99 (paranuclear dot-like positivity) and negative for LCA, CD3, CD20, cytokeratin, synaptophysin, chromogranin, and terminal deoxynucleotidyl transferase. Ki67 index was approximately 50 to 60%. Baseline 18F-fluro-deoxyglucose positron emission tomography (18F-FDG-PET/CT) could not be done due to the ongoing coronavirus disease 2019 pandemic. She was further treated with 20 gray/5 fractions (#) palliative radiotherapy (RT) to the orbit; post palliative RT, 18F- FDG-PET/CT was performed. 18F-FDG-PET/CT was performed intravenously after injecting 370 Megabecquerel (MBq) 18F-FDG (IV). Whole body PET/CT images were acquired 45 minutes after the FDG injection.
18F-FDG-PET/CT revealed FDG avid soft tissue mass in the right paranasal sinuses ([Fig. 1A]) eroding the medial wall of the orbit. Solitary skeletal metastasis was noted on the right iliac bone and multiple bilateral cervical lymph nodes. The patient received three cycles of vincristine, dactinomycin, and cyclophosphamide (VAC) chemotherapy. Interim PET/CT showed a residual mass in the paranasal sinuses with cervical lymph nodes. Previously seen lesions showed partial treatment response ([Fig. 1B]). She received three more cycles of VAC chemotherapy and was referred for end-cycle PET/CT for treatment response. PET/CT revealed FDG avid and nonavid residual cervical lymph nodes. FDG avid soft lesions were noted in the right breast parenchyma and ovaries ([Figs. 1C], [2A–D]). Also, metastatic lytic and sclerotic skeletal lesions were noted ([Fig. 1C], [Fig. 2]). The overall impression was suggestive of disease progression. Fine-needle aspiration cytology and histopathological examination (HPE) with immunohistochemistry suggested metastatic ERMS from both sites. The patient refused further treatment and was lost to follow-up.
Fig. 1 Maximum intensity projection images of baseline positron emission tomography/computed tomography (PET/CT) reveal (A) flurodeoxyglucose (FDG) avid thickening involving paranasal sinus (PNS) and adjacent areas. Interim PET/CT (B) reveals no significant residual disease in the neck. End-cycle PET/CT (C) for treatment response reveals FDG avid metastatic involvement of right breast (red arrow), bilateral ovary (green arrow), and FDG avid lesion in left iliac bone (blue arrow).
Fig. 2 End-cycle response positron emission tomography/computed tomography (PET/CT) fused images reveal flurodeoxyglucose (FDG) avid multiple lesions in the right breast (A, B); FDG avid lesions in the bilateral ovary (C, D), and FDG avid lesion in the left iliac bone (E) corresponding to axial CT image (F) reveal lytic lesions in the left iliac bone.
Discussion
RMS is the most common soft tissue sarcoma in children. On the contrary, it is an uncommon neoplasm in adults and older population.[1] ERMS predominantly affects children in their first 5 years of life, but it may occur at older ages. ERMS typically occurs in and around the head, neck, bladder, vagina, prostate, and testicles. However, only a few primary cases are reported from the liver, brain, trachea, heart, and breast.[5] Two subtypes of ERMS are botryoid and spindle cell RMS. Sarcoma botryoides present as a grape-like lesion, particularly in the vagina or bladder. Botryoid and spindle cell RMS tends to have a better prognosis than conventional ERMS.
Lung, bone marrow, and lymph nodes are specific metastatic sites for RMS.[2] Metastasis to the breast and ovary is very rare. Our case, unfortunately, had HPE and IHC confirmed both breast and ovarian metastases. Breast metastases from RMS are exceptional, with an incidence of 6%.[9] Bilateral involvement is between 8 and 25%.[10] They occur mainly in adolescent girls, with the most primary tumors in the extremities.[9] [10] The alveolar type has a strong connection with breast deposits. Breast metastases are believed to arise due to increased vascularity and rapidly growing mammary tissue at puberty.[9] [10] Metastatic, as well as primary involvement of the ovary, is infrequent in RMS. We reviewed the literature for RMS metastasizing to the breast and ovary in the pediatric population (from age 0 to 18 years) and found 12 studies reporting breast metastasis, but ovarian metastasis was not reported ([Table 1]). Out of 54 patients, only one was male, and the rest were female, demonstrating female predominance.
|
Sr no. |
Authors (y) |
No. |
Age/sex |
Primary site |
Histology |
PET |
Outcome |
|---|---|---|---|---|---|---|---|
|
1 |
Howarth[16] et al (1979) |
6 |
11.5–16 F(n = 5) M(n = 1) |
Extremity |
Alveolar (n= 6) Mix (n = 1) |
N |
All died at 1–16 mo from breast metastasis |
|
2 |
Bohman[17] et al (1982) |
3 |
15–18 All F |
Extremity, orbit, mandible |
NA |
N |
NA |
|
3 |
Copeland[18] et al (1985) |
3 |
13–15 All F |
Perineum |
Alveolar |
N |
All died at 7–27 mo from diagnosis |
|
4 |
Pettinato[19] et al (1989) |
2 |
14–17 All F |
NA. |
Alveolar (n= 1) Embryonal (n= 1) |
N |
NA |
|
5 |
Chan et al[20] (1991) |
2 |
14–15 All F |
Pelvis, perirectal |
Alveolar |
N |
NA |
|
6 |
Rogers et al[21] (1994) |
2 |
12–16 All F |
Perineum, extremity |
Alveolar (n= 1) Primitive (n = 1) |
N |
All died of PD |
|
7 |
Kwan et al[22] (1996) |
2 |
14–15 All F |
Extremity |
Alveolar |
N |
Died with PD |
|
8 |
Hays et al[23] (1997) |
19 |
12–21 All F |
Extremity (n = 8) Nasopharynx and paranasal sinus (n = 7) Trunk (n = 4) |
Alveolar |
N |
Died with PD (n = 3) Alive with disease (n = 3) No evidence of disease (n = 3) |
|
9 |
Vishnevskaia[24] et al (2004) |
2 |
14 All F |
Widespread metastasis |
Alveolar |
NA |
Died within 3 mo–1.5 y |
|
10 |
D'Angelo[25] et al (2010) |
7 |
13-16 All F |
Extremity (n = 3) vagina (n = 1) breast (n = 1) retroperitoneal (n = 1) |
Alveolar |
NA |
All dead at 15–48 mo |
|
11 |
Kebudi[26] et al (2017) |
3 |
13–14/F |
Extremity, perineum, sphenoid sinus |
Alveolar |
Y (n = 3) |
Died with PD |
|
12 |
Audino[27] et al (1995) |
3 |
14–16 All F |
Extremity |
Alveolar |
Y (n = 3) |
Died(n = 1) In remission(n = 2) |
- Ruiz-Mesa C, Goldberg JM, Coronado Munoz AJ, Dumont SN, Trent JC. Rhabdomyosarcoma in adults: new perspectives on therapy. Curr Treat Options Oncol 2015; 16 (06) 27 DOI: 10.1007/s11864-015-0342-8.
- Hettmer S, Li Z, Billin AN. et al. Rhabdomyosarcoma: current challenges and their implications for developing therapies. Cold Spring Harb Perspect Med 2014; 4 (11) a025650 DOI: 10.1101/cshperspect.a025650.
- Drummond CJ, Hatley ME. A case of mistaken identity: rhabdomyosarcoma development from endothelial progenitor cells. Mol Cell Oncol 2018; 5 (04) e1448246 DOI: 10.1080/23723556.2018.1448246.
- Xia SJ, Rajput P, Strzelecki DM, Barr FG. Analysis of genetic events that modulate the oncogenic and growth suppressive activities of the PAX3-FKHR fusion oncoprotein. Lab Invest 2007; 87 (04) 318-325
- Dagher R, Helman L. Rhabdomyosarcoma: an overview. Oncologist 1999; 4 (01) 34-44
- Lawrence Jr W, Hays DM, Moon TE. Lymphatic metastasis with childhood rhabdomyosarcoma. Cancer 1977; 39 (02) 556-559
- Hays DM, Shimada H, Raney Jr RB. et al. Clinical staging and treatment results in rhabdomyosarcoma of the female genital tract among children and adolescents. Cancer 1988; 61 (09) 1893-1903
- Agarwala S. Pediatric rhabdomyosarcomas and nonrhabdomyosarcoma soft tissue sarcoma. J Indian Assoc Pediatr Surg 2006; 11 (01) 15-23
- Birjawi GA, Haddad MC, Tawil AN, Khoury NJ. Metastatic rhabdomyosarcoma to the breast. Eur Radiol 2001; 11 (04) 555-558
- Wurdinger S, Schütz K, Fuchs D, Kaiser WA. Two cases of metastases to the breast on MR mammography. Eur Radiol 2001; 11 (05) 802-806
- Donner D, Feraco P, Meneghello L, Rombi B, Picori L, Chierichetti F. Usefulness of 18f-FDG PET-CT in staging, restaging, and response assessment in pediatric rhabdomyosarcoma. Diagnostics (Basel) 2020; 10 (12) 1112 DOI: 10.3390/diagnostics10121112.
- Metabolic response as assessed by 18F‐fluorodeoxyglucose positron emission tomography‐computed tomography does not predict outcome in patients with intermediate‐ or high‐risk Rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee - Harrison - 2021 - Cancer Medicine - Wiley Online Library. Accessed March 26, 2023 at:. https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3667
- Crist WM, Anderson JR, Meza JL. et al. Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol 2001; 19 (12) 3091-3102
- Maurer HM, Gehan EA, Beltangady M. et al. The intergroup rhabdomyosarcoma study-II. Cancer 1993; 71 (05) 1904-1922
- Sandler E, Lyden E, Ruymann F. et al. Efficacy of ifosfamide and doxorubicin given as a phase II “window” in children with newly diagnosed metastatic rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study Group. Med Pediatr Oncol 2001; 37 (05) 442-448
- Howarth CB, Caces JN, Pratt CB. Breast metastases in children with rhabdomyosarcoma. Cancer 1980; 46 (11) 2520-2524
- Bohman LG, Bassett LW, Gold RH, Voet R. Breast metastases from extramammary malignancies. Radiology 1982; 144 (02) 309-312
- Copeland LJ, Sneige N, Stringer CA, Gershenson DM, Saul PB, Kavanagh JJ. Alveolar rhabdomyosarcoma of the female genitalia. Cancer 1985; 56 (04) 849-855
- Pettinato G, Manivel JC, Kelly DR, Wold LE, Dehner LP. Lesions of the breast in children exclusive of typical fibroadenoma and gynecomastia. A clinicopathologic study of 113 cases. Pathol Annu 1989; 24 (Pt 2): 296-328
- Chan KW, Rogers PC, Fryer CJ. Breast metastases after bone marrow transplantation for rhabdomyosarcoma. Bone Marrow Transplant 1991; 7 (02) 171-172
- Rogers DA, Lobe TE, Rao BN. et al. Breast malignancy in children. J Pediatr Surg 1994; 29 (01) 48-51
- Kwan WH, Choi PH, Li CK. et al. Breast metastasis in adolescents with alveolar rhabdomyosarcoma of the extremities: report of two cases. Pediatr Hematol Oncol 1996; 13 (03) 277-285
- Hays DM, Donaldson SS, Shimada H. et al. Primary and metastatic rhabdomyosarcoma in the breast: neoplasms of adolescent females, a report from the Intergroup Rhabdomyosarcoma Study. Med Pediatr Oncol 1997; 29 (03) 181-189
- Vishnevskaia IaV, Sharoev TA, Stepanova EV, Osipova LV. [Rhabdomyosarcoma of the breast in girls]. Arkh Patol 2004; 66 (04) 47-51
- D'Angelo P, Carli M, Ferrari A. et al; AIEOP Soft Tissue Sarcoma Committee. Breast metastases in children and adolescents with rhabdomyosarcoma: experience of the Italian Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2010; 55 (07) 1306-1309
- Kebudi R, Koc BS, Gorgun O, Celik A, Kebudi A, Darendeliler E. Breast metastases in children and adolescents with rhabdomyosarcoma: a large single-institution experience and literature review. J Pediatr Hematol Oncol 2017; 39 (01) 67-71
- Audino AN, Setty BA, Yeager ND. Rhabdomyosarcoma of the breast in adolescent and young adult (AYA) women. J Pediatr Hematol Oncol 2017; 39 (01) 62-66
Address for correspondence
Publication History
Article published online:
28 April 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
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Fig. 1 Maximum intensity projection images of baseline positron emission tomography/computed tomography (PET/CT) reveal (A) flurodeoxyglucose (FDG) avid thickening involving paranasal sinus (PNS) and adjacent areas. Interim PET/CT (B) reveals no significant residual disease in the neck. End-cycle PET/CT (C) for treatment response reveals FDG avid metastatic involvement of right breast (red arrow), bilateral ovary (green arrow), and FDG avid lesion in left iliac bone (blue arrow).
Fig. 2 End-cycle response positron emission tomography/computed tomography (PET/CT) fused images reveal flurodeoxyglucose (FDG) avid multiple lesions in the right breast (A, B); FDG avid lesions in the bilateral ovary (C, D), and FDG avid lesion in the left iliac bone (E) corresponding to axial CT image (F) reveal lytic lesions in the left iliac bone.
References
- Ruiz-Mesa C, Goldberg JM, Coronado Munoz AJ, Dumont SN, Trent JC. Rhabdomyosarcoma in adults: new perspectives on therapy. Curr Treat Options Oncol 2015; 16 (06) 27 DOI: 10.1007/s11864-015-0342-8.
- Hettmer S, Li Z, Billin AN. et al. Rhabdomyosarcoma: current challenges and their implications for developing therapies. Cold Spring Harb Perspect Med 2014; 4 (11) a025650 DOI: 10.1101/cshperspect.a025650.
- Drummond CJ, Hatley ME. A case of mistaken identity: rhabdomyosarcoma development from endothelial progenitor cells. Mol Cell Oncol 2018; 5 (04) e1448246 DOI: 10.1080/23723556.2018.1448246.
- Xia SJ, Rajput P, Strzelecki DM, Barr FG. Analysis of genetic events that modulate the oncogenic and growth suppressive activities of the PAX3-FKHR fusion oncoprotein. Lab Invest 2007; 87 (04) 318-325
- Dagher R, Helman L. Rhabdomyosarcoma: an overview. Oncologist 1999; 4 (01) 34-44
- Lawrence Jr W, Hays DM, Moon TE. Lymphatic metastasis with childhood rhabdomyosarcoma. Cancer 1977; 39 (02) 556-559
- Hays DM, Shimada H, Raney Jr RB. et al. Clinical staging and treatment results in rhabdomyosarcoma of the female genital tract among children and adolescents. Cancer 1988; 61 (09) 1893-1903
- Agarwala S. Pediatric rhabdomyosarcomas and nonrhabdomyosarcoma soft tissue sarcoma. J Indian Assoc Pediatr Surg 2006; 11 (01) 15-23
- Birjawi GA, Haddad MC, Tawil AN, Khoury NJ. Metastatic rhabdomyosarcoma to the breast. Eur Radiol 2001; 11 (04) 555-558
- Wurdinger S, Schütz K, Fuchs D, Kaiser WA. Two cases of metastases to the breast on MR mammography. Eur Radiol 2001; 11 (05) 802-806
- Donner D, Feraco P, Meneghello L, Rombi B, Picori L, Chierichetti F. Usefulness of 18f-FDG PET-CT in staging, restaging, and response assessment in pediatric rhabdomyosarcoma. Diagnostics (Basel) 2020; 10 (12) 1112 DOI: 10.3390/diagnostics10121112.
- Metabolic response as assessed by 18F‐fluorodeoxyglucose positron emission tomography‐computed tomography does not predict outcome in patients with intermediate‐ or high‐risk Rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee - Harrison - 2021 - Cancer Medicine - Wiley Online Library. Accessed March 26, 2023 at:. https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3667
- Crist WM, Anderson JR, Meza JL. et al. Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol 2001; 19 (12) 3091-3102
- Maurer HM, Gehan EA, Beltangady M. et al. The intergroup rhabdomyosarcoma study-II. Cancer 1993; 71 (05) 1904-1922
- Sandler E, Lyden E, Ruymann F. et al. Efficacy of ifosfamide and doxorubicin given as a phase II “window” in children with newly diagnosed metastatic rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study Group. Med Pediatr Oncol 2001; 37 (05) 442-448
- Howarth CB, Caces JN, Pratt CB. Breast metastases in children with rhabdomyosarcoma. Cancer 1980; 46 (11) 2520-2524
- Bohman LG, Bassett LW, Gold RH, Voet R. Breast metastases from extramammary malignancies. Radiology 1982; 144 (02) 309-312
- Copeland LJ, Sneige N, Stringer CA, Gershenson DM, Saul PB, Kavanagh JJ. Alveolar rhabdomyosarcoma of the female genitalia. Cancer 1985; 56 (04) 849-855
- Pettinato G, Manivel JC, Kelly DR, Wold LE, Dehner LP. Lesions of the breast in children exclusive of typical fibroadenoma and gynecomastia. A clinicopathologic study of 113 cases. Pathol Annu 1989; 24 (Pt 2): 296-328
- Chan KW, Rogers PC, Fryer CJ. Breast metastases after bone marrow transplantation for rhabdomyosarcoma. Bone Marrow Transplant 1991; 7 (02) 171-172
- Rogers DA, Lobe TE, Rao BN. et al. Breast malignancy in children. J Pediatr Surg 1994; 29 (01) 48-51
- Kwan WH, Choi PH, Li CK. et al. Breast metastasis in adolescents with alveolar rhabdomyosarcoma of the extremities: report of two cases. Pediatr Hematol Oncol 1996; 13 (03) 277-285
- Hays DM, Donaldson SS, Shimada H. et al. Primary and metastatic rhabdomyosarcoma in the breast: neoplasms of adolescent females, a report from the Intergroup Rhabdomyosarcoma Study. Med Pediatr Oncol 1997; 29 (03) 181-189
- Vishnevskaia IaV, Sharoev TA, Stepanova EV, Osipova LV. [Rhabdomyosarcoma of the breast in girls]. Arkh Patol 2004; 66 (04) 47-51
- D'Angelo P, Carli M, Ferrari A. et al; AIEOP Soft Tissue Sarcoma Committee. Breast metastases in children and adolescents with rhabdomyosarcoma: experience of the Italian Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2010; 55 (07) 1306-1309
- Kebudi R, Koc BS, Gorgun O, Celik A, Kebudi A, Darendeliler E. Breast metastases in children and adolescents with rhabdomyosarcoma: a large single-institution experience and literature review. J Pediatr Hematol Oncol 2017; 39 (01) 67-71
- Audino AN, Setty BA, Yeager ND. Rhabdomyosarcoma of the breast in adolescent and young adult (AYA) women. J Pediatr Hematol Oncol 2017; 39 (01) 62-66