Jerry Howard (University of Missouri/Columbia/USA)  

Viewable for logged on visitors (Log on)  

2 Years  

Male  

Neck-Other and unknown  

neoplastic  

2 yo male presents to the ED with nausea and vomiting and altered mental status and a pre auricular mass. Chemistry analysis revealed marked hypercalcemia. KUB performed to evaluate for renal calculi which did not show any calculi. However, pelvis had several areas of mottling. CT head performed because of altered mental status and nausea/vomiting. A soft tissue mass noted in the right masticator space with intracranial extension via the foramen ovale. CT chest, abdomen, and pelvis was then performed which demonstrated diffuse axial skeletal lytic lesions.  

N/A  

<- view X-Ray 1

X-Ray 1: Bilateral iliac bones and proximal femora have a subtle mottled appearance.





<- view CT 1

CT 1: post IV contrast axial CT neck: Heterogeneous enhancing mass in the right masticator space.





<- view CT 2

CT 2: IV contrast CT neck coronal reformats: Right masticator space widens and extends through the foramen ovale into the cavernous sinus/Meckel’s cave.





<- view CT 3

CT 3: IV contrast CT neck coronal reformat:Right masticator space heterogeneous enhancing soft tissue mass which causings splaying of the internal and external carotid arteries.





<- view MRI 1

MRI 1: MRI axial T1 pre contrast : Right masticator space heterogeneous soft tissue signal intensity mass obliterates fat planes.





<- view MRI 2

MRI 2: MRI axial T1 post contrast: Right masticator space heterogeneously enhancing soft tissue signal intensity mass.





<- view MRI 3

MRI 3: MRI T2 coronal: right masticator space mass extends into right cavernous sinus/Meckel's cave via foramen ovale.



 

Dissection / Histo  

Peds: Lymphoma, Rhabdomyosarcoma, Metastatic disease (Neuroblastoma), Osteosarcoma, Ewing sarcoma, Schwannoma (V3), PNET

Adolescents: Juvenile angiofibroma via pterygomaxillary fissure

Adults: Minor salivary tumor or squamous cell carcinoma via extension from anterior buccal space; schwannoma and meningioma via foramen ovale. Intinsic masses: Malignant fibrous histiocytoma, fibrosarcoma, hemangiosarcoma, metastasis
 

Over several months, the patient underwent several rounds of chemoradiation treatment with an excellent response.

Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma, constituting 3-5% of all malignancies in childhood. In 40% of childhood cases of rhabdomyosarcoma, the tumor is located in the head/neck region, making only second to lymphoma. Other common sites RMS is found are genitourinary tract and extremities. RMS presents in a bimodal distribution between 2-4 years and 12-16 years.  

N/A  

First case of rhabdomyosarcoma was described in 1854 by Webner in a young patient with tongue cancer. In 1946, Stout published a series of case reports of adults with rhabdomyosarcoma involving the trunk and limbs. Little over a decade later, in 1958, Horn and Enterline proposed a classification of the tumor into four subgroups: embryonal, alveolar, botryoid, and pleomorphic.  

1. Medline:
Andrassy, R.; Hayes-Jordan, A.
“Rhabdomyosarcoma in Children”
Current Opinions in Pediatrics.

2. Medline:
Wei, Y; Xia, J.
“Masticator Space: CT and MRI of secondary Tumor Spread”
American Journal of Roentgenology

3. Medline:
Adam, R.; Balm, A.; Bras, J.
"Imaging Findings in Craniofacial Childhood Rhabdomyosarcoma"
Pediatric Radiology

4. Medline:
Paidas, C; Rodeberg, D.
"Childhood Rhabdomyosarcoma"
Seminars in Pediatric Surgery  

rhabdomyosarkom, masticator space, child, childhood, pediatric radiology  

Jerry Howard. Rhabdomyosarcoma. PedRad [serial online] vol 10, no. 10.
URL: www.PedRad.info/?search=20101002024050