PMC10070266_01
Cervical and dorsal magnetic resonance imaging in sagittal T2-weighted sequence (a) and T1-weighted sequence with gadolinium (b and d), and in axial T2-weighted sequence at the level of the first dorsal vertebra (c). It shows the pathologic fracture of the latter with the epidural extension of the rhabdomyosarcoma (a and b), also the prevertebral right-sided part of the tumor (star) and its anterior bilateral invasion of the canal causing cord compression (arrows). Note the infiltration of the right pedicle and lower facet of the third dorsal vertebra (d arrow).
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F1
The cervical MRI showed a right anterolateral preverbal/vertebral C7/T1 homogeneously enhancing lesion, a pathologic fracture of the T1 body, and epidural compression [Figure 1]. T3 vertebral pedicle [Figure 1]. The differential diagnoses included multifocal spinal lymphoma versus multiple metastases.
Lumbosacral magnetic resonance imaging in sagittal cuts T1-weighted sequence (a), T2-weighted sequence (b), and T1 with gadolinium (c), and axial cut T2-weighted sequence, focused on the sacrum. It shows the tumor starting in the pre-sacral space (star), infiltrating the sacrum mainly to the left ala with sacral canal invasion and gluteal muscle infiltration (d arrows).
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F2
A similar lesion was found at the S1-S2 level, contributing to the cauda equina compression [Figure 2].
Photomicrographs of our patient (a) with H-E staining, magnification x20, showing high cellular proliferation of primitive round cells with nested and alveolar patterns. (b) immunohistochemistry study, showing extensive nuclear positivity of tumor cells to myogenin.
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F3
Furthermore, the immunohistochemistry revealed a highly malignant RMS [Figure 3].