Ultrasound of urinary bladder rhabdomyosarcoma

Discussion:

The patient underwent cystoscopic biopsy at specialist Children's Hospital. A diagnosis of Embryonal Botryoid Rhabdomyosarcoma was made on biopsy

Pediatric urinary bladder masses are uncommon and majority are benign. The site of origin may be urothelial or mesenchymal. Rarely,  other masses like paragangliomas can arise from chromaffin cell rests.

Imaging appearance is non specific and standard for diagnosis is cystoscopic biopsy.

Rhabdomyosarcoma is the commonest malignant mass. It may be embryonal or non- embryonal, with the latter having the worse prognosis.

Embryonal rhabdomyosarcomas could further be botryoid or alveloar. Botryoid variety can show 'bunch of grapes' appearance on imaging.

Work up for staging includes CT lungs, MR pelvis (for regional nodes), bone scan and PET scan, to exclude metastases to lungs, nodes or bones.

Chemotherapy is first line of treatment and usually curative. If it fails partial or total cystectomy may be needed. Annual surveillance on ultrasound to detect recurrence may be advisable.

 

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