Tran's Arterial Embolization of an Unusual Pleomorphic Rhabdomyosarcoma in Adulthood for Better Preoperative Conditioning

Abstract

Rhabdomyosarcomas, being the most common sarcomas of childhood, have an extremely poor prognosis, and pleomorphic rhabdomyosarcomas occur very rarely in adults. Despite advanced diagnostics, it is not uncommon for such tumours to be misinterpreted. The 73-year-old patient was diagnosed with a swelling on the inner side of the left thigh 3 years previously after a minor trauma, which was interpreted as a small well-revascularised haemangioma in original CT angiography. While this mass showed little change over the last 2.5 years, a sudden progression of growth occurred 6 months ago. With the working diagnosis of a haemangioma, differential diagnosis of a schwanoma, the vessels supplying the tumour from profunda femoral artery were visualised preoperatively in a selective angiography and embolised. Shortly before the operation, dupex sonography revealed a renewed hypervasculariasis of the tumour. The supplied vessels from the superficial femoral artery and from the main left profunda trunc were embolised with Embosphere Microspheres 500-700 (Merit). Complete devascularisation of the tumour was achieved, so that the tumour could be resected very effectively in accordance with the compartment. The histological work-up of the tumour resulted in the diagnosis of a pleomorphic rhabdomyosarcoma grade II with tumor-free margins. Preoperative embolisation could be an effective method for preoperative conditioning of such rhabdomyosarcoma. Using this example, this study discusses the current diagnostic and therapeutic options for adult rhabdomyosarcomas.