PMC4899549_01
15-year-old female with metastatic rhabdomyosarcoma. Bilateral mammogram demonstrates diffusely increased density within the right breast.
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A subsequent mammogram showed a unilateral dense right breast (Fig. 1).
15-year-old female with metastatic rhabdomyosarcoma. Frontal chest radiograph shows multiple findings including asymmetrically enlarged right breast, mediastinal lymphadenopathy, small bilateral pleural effusions, and pulmonary opacities.
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A chest radiograph was remarkable for intrathoracic lymphadenopathy and diffuse pulmonary opacities (Fig. 2).
15-year-old female with metastatic rhabdomyosarcoma. Maximum intensity projection (MIP) image reveals extensive hypermetabolic activity within the right breast, lungs, axial and proximal appendicular skeleton, right foot, and lymph nodes of the chest, abdomen, pelvis, right inguinal region, and right popliteal fossa.
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The largest and most hypermetabolic of these soft-tissue masses was located along the plantar surface at the level of the metatarsals (Figure 3, Figure 4).
15-year-old female with metastatic rhabdomyosarcoma. Fusion image of the chest better details hypermetabolic activity in a diffusely enlarged and dense right breast, extensive pulmonary involvement, and intrathoracic lymphadenopathy.
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The largest and most hypermetabolic of these soft-tissue masses was located along the plantar surface at the level of the metatarsals (Figure 3, Figure 4).
15-year-old female with metastatic rhabdomyosarcoma. Fusion image from a subsequent PET/CT shows a new hypermetabolic focus in the far left lateral breast.
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However, a new hypermetabolic focus in the lateral left breast was identified (Fig. 5).
15-year-old female with metastatic rhabdomyosarcoma. Correlative ultrasound demonstrates a mass with heterogeneous echogenicity in the left axillary tail with irregular margins and internal vascularity, suspicious for a new metastasis.
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Ultrasound confirmed the presence of a 2.2cm left axillary tail mass with suspicious features (Fig. 6).
15-year-old female with metastatic rhabdomyosarcoma. The core biopsy demonstrated sheets of small round blue cells, separated by a framework of dense fibrous septa, with formation of irregular "alveolar" spaces and central loss of cellular cohesion. This is consistent with a poorly differentiated small blue-round-cell tumor.
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Histopathology from subsequent core-needle biopsy was consistent with metastatic alveolar rhabdomyosarcoma (Figure 7, Figure 8).
15-year-old female with metastatic rhabdomyosarcoma. The tumor cells stained positive for myogenic markers, including myogenin (left) and myoD1 (right). They were negative for pancytokeratin, CD45, and S100 (not shown). The cytogenetic study (not shown) revealed a FOX01 (FKHR) gene rearrangement on chromosome 13q14. These findings are consistent with alveolar rhabdomyosarcoma.
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Histopathology from subsequent core-needle biopsy was consistent with metastatic alveolar rhabdomyosarcoma (Figure 7, Figure 8).
15-year-old female with metastatic rhabdomyosarcoma. Gradient echo (A) demonstrates intracranial hemorrhagic metastases with fluid-fluid levels. Post-contrast (B) image shows leptomeningeal enhancement surrounding the mass in the left inferior parietal lobule.
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MRI of the brain showed multiple intra-axial hemorrhagic metastases, the largest of which was in the left inferior parietal lobule (Fig. 9).