PMC4861848_01
A 35-year-old woman with alveolar rhabdomyosarcoma of the ethmoid sinus metastatic to the breast. A. Coronal T1-weighted, postcontrast, fat-saturated MRI of the face shows lobulated, enhancing soft tissue involving the right ethmoidal air cells and the medial wall of the right orbit (arrow) after surgical intervention.. B. Axial, contrast-enhanced CT image of the neck shows right submandibular metastatic lymphadenopathy (arrow), enlarged compared to a prior examination.
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At the time of presentation, the patient had completed two rounds of chemotherapy and two rounds of radiation therapy for the primary ethmoid sinus tumor and a metastatic right submandibular lymph node (Fig. 1B).
A 35-year-old woman with alveolar rhabdomyosarcoma of the ethmoid sinus metastatic to the breast. Mammography shows an 8mm left breast subareolar mass (arrow) in the region of the palpable abnormality. A. Craniocaudal view. B. Lateromedial view. C. Photographically magnified craniocaudal view. D. Photographically magnified lateromedial view.
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Mammography (Fig. 2) revealed a mass measuring 8 millimeters in the subareolar region of the left breast, corresponding to a palpable abnormality.
A 35-year-old woman with alveolar rhabdomyosarcoma of the ethmoid sinus metastatic to the breast. Before ultrasound-guided fine-needle aspiration, targeted left-breast ultrasound, focusing on the left retroareolar palpable mass (arrow), was performed (A: Transverse view. B: Longitudinal view).
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A 35-year-old woman with alveolar rhabdomyosarcoma of the ethmoid sinus metastatic to the breast. Direct smear of material from the ultrasound-guided, fine-needle aspiration of the breast mass stained by the Papanicolaou method shows a loose cluster (A) and single tumor cells (B) with fine nuclear chromatin, a high nuclear-cytoplasmic ratio, and scant cytoplasm. Immunohistochemical staining for myogenin (C) shows diffuse and strong nuclear positivity, supporting the diagnosis of rhabdomyosarcoma.
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These findings were consistent with metastasis from the patient's known alveolar rhabdomyosarcoma (Fig. 4).