Metastases to the breast - rhabdomyosarcoma

Case contributed by Dr Ammar Ashraf

Presentation

Follow up case of rhabdomyosarcoma of the scalp with incidental finding of right breast nodule.

Patient Data

Age: 15 years
Gender: Female

Well defined lobulated soft tissue mass measuring 2.3 x 1.7 cm seen in the lower part of the right breast. Moderate to marked abdominopelvic ascites, extensive nodular peritoneal/omental deposits and multiple enlarged paraaortic lymph nodes. Relatively small left kidney and mild bilateral hydronephrosis. Bilateral double J stents seen in place. Small bilateral pleural effusions with atelectatic changes in the underlying lungs. Generalized edematous changes in the subcutaneous soft tissues of the abdomen. Heterogeneous bone density of the axial skeleton that may be related to the chronic renal impairment; other possibility can be bone metastases

A hypoechoic lobulated solid lesion measuring 15 x 24 mm is seen at 8 o'clock position in the right breast. It has irregular margins and shows internal vascularity on color Doppler ultrasound examination.

Case Discussion

Procedure: Ultrasound-guided Tru-cut biopsy of the right breast nodule.

Diagnosis: Metastatic embryonal rhabdomyosarcoma.  

The immunostain with the antibody anti-CD45 is negative, desmin is +++, CD99 focally positive.  Synaptophysin is negative and Ki67 is very high (>70%). The positivity of desmin is consistent with the diagnosis of rhabdomyosarcoma (embryonal).

Ascitic fluid analysis was also positive for metastatic rhabdomyosarcoma.  

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