Embryonal rhabdomyosarcoma of the uterine cervix in a pregnant woman

Abstract

Rhabdomyosarcomas (RMSs) are extremely malignant tumorsoriginating from myogenic progenitor cells and show variablestages of skeletal muscle differentiation [1]. They are the mostcommon soft tissue sarcomas in children and young adults, rep-resenting 3e6%of all malignancies in this agegroup[2,3]. The headand neck is the most common site of RMSs, followed by the geni-tourinary tract [4]. Twenty percent of primary lesions are localizedin the genitourinary tract, with slightly more than half being theembryonal RMS type [5].According to the Intergroup RMS Study Group, there are fourhistologic subtypes of RMSs: botryoid and spindle cell, embryonal,alveolar, and undifferentiated types. The majority of RMSs arisingfromthefemalegenitaltractarebotryoidtype,whichisavariantofembryonal rhabdomyosarcoma (ERMS). It arises within the wall ofthe bladder or vagina almost exclusively in infants, whereas it canalso arise elsewhere in older children [6]. The sarcoma botryoidesof the cervix uteri very rarely occurs in fertile age; it only accountsfor 0.2% of all malignant tumors of the uterus. At this localization,the tumor arises from the cervical mucosal epithelium or themiddle tunica, and usually appears as a cervical polyp protrudingouttheexternalorifice.Thetumorhasafastgrowthpattern,mainlyspreading to the lungs and liver by blood circulation [7].The etiology and specific risk factors are not known [6]. Diag-nosis is very challenging because these tumors frequently posedifficult problems during diagnostic procedures, and advancedtechniques such as immunohistochemical staining are oftenrequired to establish a definite diagnosis. Evaluation of the diag-nosticmaterialbyapathologistwithspecialexpertiseinthisareaisof utmost importance.We report a case of ERMS of the uterine cervix in a pregnantwoman. To the best of our knowledge, this is the first reported caseof ERMS arising from the uterine cervix in a pregnant woman ac-cording to the literature search we carried out on PUBMED for theperiod of 1971e2013.A 30-year-old, pregnant woman presented to the affiliatedoutside clinic with spotting during her 6