Rhabdomyosarcoma

Case contributed by Khaloud Alghamdi

Presentation

Slow-onset progressive swelling of the right hypothenar eminence.

Patient Data

Age: 15 years
Gender: Female
  • lobulated oval soft tissue mass surrounding the diaphysis of the fifth metacarpal at the palmar surface (hypothenar eminence).
  • The mass shows high signal on fluid sensitive sequences with few millimetric cystic changes and multiple hypointense linear septa. It also shows avid heterogenous enhancement postcontrast administration.
  • The mass causes scalloping with cortical loss of the palmar fifth metacarpal cortex at the mid diaphysis with marked bone marrow edema of the fifth metacarpal and adjacent soft tissue.
  • The mass surrounds approximately 50% of the diameter of the proximal flexor digiti minimi tendon and completely encases the proximal extensor digiting minimi causing mild narrowing of the tendon.

Case Discussion

Mass lesions in the extremities have a wide differential.  Radiographs are usually the first line investigation followed by MRI if there are aggressive features shown.  Enhancing soft tissue masses on MRI indicates an aggressive pathology.  The patient was referred to orthopedic surgery for resection.  Histopathological analysis confirmed rhabdomyosarcoma.

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