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Primary rhabdomyosarcoma of the heart presenting with increased intracranial pressure.

An 18-month-old boy presented with signs of increased intracranial pressure. Computed tomographic scans of the brain and lungs showed multiple masses in the brain and lungs. Echocardiography revealed homogeneous, irregular pericardial thickening, minimal pericardial effusion, and irregular echogenic areas in the left ventricular inferoposterior and apical regions. Postmortem examination of tumor tissue showed that the masses were primary rhabdomyosarcoma of the left ventricle with multiple metastases. Primary rhabdomyosarcoma of the heart is uncommon, especially in patients under 2 years of age.

Brain↗

Perianal alveolar rhabdomyosarcoma in a child. Report of a long-term survival case.

The long-term survival of alveolar rhabdomyosarcoma of the perianal region in a 13-month-old infant is described. Local excision with chemotherapy consisting of vincristine, actinomycin D, and cyclophosphamide over a period of two years has resulted in eight years of tumor-free survival with normal growth and development. Our case and review of the literature suggest that local excision with chemotherapy may be an appropriate treatment for Group I perianal rhabdomyosarcoma in children.

Antineoplastic Combined Chemotherapy Protocols↗

Rhabdomyosarcoma.

Rhabdomyosarcoma, the most common soft tissue sarcoma of children, carried a 10-15% survival rate in the late 1960s. Since then, better understanding of biology and pathology of the tumor and the judicious use of chemotherapy and radiation has improved the prognosis drastically. In addition instead of extirpative surgery, organ salvage is now feasible in many of these children. In this article the authors review current information regarding pathology, diagnosis and treatment of rhabdomyosarcoma.

Combined Modality Therapy↗

Botryoid rhabdomyosarcoma of common bile duct.

Common bile duct is an unusual site for occurrence of botryoid rhabdomyosarcoma. Clinically it is often misdiagnosed as infectious hepatitis. Early diagnosis and treatment has greatly improved the prognosis of this aggressive neoplasm. Here the authors present a case report of Bortroyid Rhabdomyosarcoma of CBD in a two and half year old child masquerading as obstructive jaundice.

Child, Preschool↗

Primary cerebral rhabdomyosarcoma.

Primary intracranial rhabdomyosarcomas are extremely rare tumors; those in the supratentorial location are commoner in adults. A 10 year old girl with primary cerebral rhabdomyosarcoma is presented.

Brain Neoplasms↗

Glycosphingolipids of an alveolar rhabdomyosarcoma and normal human muscle. A case study.

The distribution of neutral, or asialosyl-, glycosphingolipids and gangliosides in a rhabdomyosarcoma of alveolar type have been studied. Histologically, this muscle tumor is composed primarily of two cell types: one with oval or round hyperchromatic nuclei and very little cytoplasm, and one a giant cell, with multiple, peripherally placed nuclei and weakly staining eosinophillic cytoplasm. In comparing glycolipids of the rhabdomyosarcoma with normal muscle from the same leg, the striking alteration in the tumor was a virtual disappearance of ganglioside GM2. There was also a slight increase in GM3 and a decrease in GD1a. The asialosyl derivative of GM2 (GalNac-Gal-Glc-Cer) was markedly increased in the tumor. A loss of glucosylceramide was also observed. The results are discussed in terms of glycolipid metabolic changes in muscle oncogenesis and their implications.

Child, Preschool↗

Pleomorphic rhabdomyosarcoma of the uterus in a postmenopausal patient.

Pure rhabdomyosarcomas occurring in the adult uterus are very rare, with poor prognosis. We present a case of a 67-year-old woman with postmenopausal vaginal bleeding caused by pleomorphic rhabdomyosarcoma of the uterus, treated with hysterectomy, bilateral salpingo-oophorectomy, pelvic/paraaortic lymphadenectomy and partial sigmoidectomy. Postoperative chemotherapy (Doxorubicin) was given according to protocol. Follow-up examinations one year after surgery revealed no abnormalities or tumor recurrence. The rarity of this histological entity makes the presented case worthy of publication.

Aged↗

The intraclonal and interclonal phenotypic heterogeneity in a rhabdomyosarcoma cell line with abortive imitation of embryonic myogenesis.

Three distinct subpopulations (A, B, C) derived from a dimethylbenzanthracene-induced rat rhabdomyosarcoma were established as permanent cell lines. Although the clonal nature of each of these subpopulations was confirmed by repeated recloning procedures, a striking intraclonal phenotypic heterogeneity was observed. By means of immunofluorescence microscopy and transmission electron microscopy, it could be shown that these subpopulations closely recapitulate stages of embryonic rhabdomyogenesis both in vitro and in vivo, but differ in their particular range of maximum differentiation. Embryonic rhabdomyogenesis is imitated most perfectly by subpopulation C, in which multinuclear myotubes are formed in vitro by fusion of mononuclear cells, and alpha-sarcomeric actin is expressed in the multinuclear cells and in a few mononuclear cells. After retransplantation in vivo, subpopulation C further proceeds in fine structural differentiation, now exhibiting myofibrils with a sarcomeric organization in the myotube-like giant cells. The cells of subpopulation B do not exceed the stage of mononuclear desmin-positive cells in vitro, but synthesize thin and thick myofilaments after retransplantation in vivo. The cells of subpopulation A recapitulate embryonic rhabdomyogenesis least successfully being confined to the stage of mononuclear desmin-positive cells. Thus, the coexistence of diverse subpopulations and the cellular maturation within these subpopulations together contribute to the phenotypic heterogeneity of rhabdomyosarcomas.

Animals↗

Terminally differentiated postmitotic tumor cells in a rat rhabdomyosarcoma cell line.

A permanent rat rhabdomyosarcoma cell line (BA-HAN-1C) has been established, the phenotype of which is characterized by the coexistence of undifferentiated mononuclear cells and differentiated multinuclear myotube-like giant cells. The failure of attempts to separate these two cell types by repeated recloning procedures indicates their close histogenetic relationship and suggests that differentiation in this tumor proceeds in a similar manner to that in normal striated muscle where postmitotic myotubes arise from mononuclear myoblasts by fusion. The morphologically undifferentiated mononuclear tumor cells were shown to be actively proliferating and to incorporate thymidine methyl-3H(3H-TdR). The myotube-like giant cells neither incorporated 3H-TdR nor underwent mitosis or exhibited any clonogenic potential. After retransplantation into syngenic rats, tumor growth was markedly retarded when the tumor cell inoculum contained a high percentage of myotube-like giant cells. These data show that proliferative activity in this rhabdomyosarcoma cell line is confined to the mononuclear tumor cell compartment, the multinuclear myotube-like giant cells having withdrawn from the cell cycle and represent terminally differentiated postmitotic cells. This cell line should provide a valuable tool for further investigation of coherent aspects of proliferation and differentiation using various differentiation inducers.

Animals↗

Pararectal rhabdomyosarcoma: report of a case.

Primary rhabdomyosarcoma of the alimentary tract is extremely rare, only 11 cases have been reported in the literature. Long-term survival in adults may be possible if the tumor is detected at an early stage even though it is asymptomatic. This highly malignant tumor can be treated by surgical excision, chemotherapy, and irradiation. A 12th case--of stage 1, pararectal, rhabdomyosarcoma--is reported.

Aged↗

The influence of recombinant human insulin-like growth factor-I (rhIGF-I) on cell growth and cytotoxicity of drugs in childhood rhabdomyosarcoma cell lines and xenograft models.

PURPOSE: Recombinant human insulin-like growth factor I (rhIGF-I) has been reported to ameliorate vincristine-induced neuropathy, the dose-limiting side effect of this antimitotic anticancer drug. However, rhIGF-I also might have adverse effects, as has been shown in vitro, where it stimulates growth of cancer cells and protects them from cytotoxicity of anticancer drugs. The influence of rhIGF-I on the cytotoxicity of vincristine has not yet been studied. Furthermore, studies performed have been done under serum-free conditions, which are far from physiological. METHODS: We studied the influence of rhIGF-I on the growth of two rhabdomyosarcoma cell lines (Rh30 and Rh1) and on the antitumor effects of vincristine, cisplatin, etoposide, doxorubicin, and topotecan under serum-free and serum-containing conditions. To extend the in vitro data, we grew Rh30 cells as xenografts in mice and determined the effects of vincristine. rhIGF-I or their combination on tumor growth. RESULTS: In vitro, both cell lines demonstrated a functional type I IGF receptor, as shown by the rapid activation of ribosomal p70 S6 kinase after stimulation with rhIGF-I. Under serum-free conditions, rhIGF-I stimulated growth of both cell lines. Exposure to cytotoxic drugs with and without rhIGF-I resulted in higher cell numbers in cultures exposed to rhIGF-I. However, relative to the appropriate control, fractional growth inhibition and or cell kill of the cytotoxic drugs was identical with and without rhIGF-I. Under serum-containing conditions, rhIGF-I had no effect on cell growth or drug cytotoxicity. In vivo we did not find a significant influence of rhIGF-I on HxRh30 cell growth, or on the antitumor activity of vincristine. CONCLUSIONS: These studies show that rhIGF-I has no adverse effects on human rhabdomyosarcoma growth or on the antitumor effect of cytotoxic drugs under serum-containing conditions in vitro or in tumor-bearing mice. Potentially, therefore, rhIGF-I may ameliorate vincristine-induced neuropathy without adversely influencing tumor growth or vincristine cytotoxicity in children.

Animals↗

Pentoxifylline enhances tumor oxygenation and radiosensitivity in rat rhabdomyosarcomas during continuous hyperfractionated irradiation.

PURPOSE: To examine the influence of the hemorrheologic agent pentoxifylline (PTX) on tumor oxygenation and radiosensitivity. MATERIAL AND METHODS: Tumor oxygenation in rat rhabdomyosarcomas R1H after PTX administration (50 mg/kg body weight) was measured using interstitial pO(2) probes (Licox CMP system and Eppendorf pO(2)-Histograph). Tumors were irradiated with (60)Co gamma-irradiation using single doses (15 and 30 Gy), conventional fractionation (60 Gy/30 fractions/6 weeks), and continuous hyperfractionation (54 Gy/36 fractions/18 days) in combination with PTX or an equivalent volume of physiological saline. Radiation effects were determined by tumor growth delay (2V(o)), and by partial and complete tumor remission. RESULTS: PTX increased tumor oxygenation for up to 45 min after administration of the drug. Single doses of 15 and 30 Gy of irradiation, when combined with PTX, produced little radiosensitization of the R1H tumors as indicated by dose-modifying factors (DMFs) of 1.11 and 1.04, respectively. In conventional fractionated irradiation with PTX, a DMF of 1.10 was obtained only. However, in continuous hyperfractionated irradiation with 18 x 50 mg/kg of PTX, the DMF with respect to tumor growth delay was found to be 1.37. Local tumor control was not influenced by PTX. In vitro studies identified R1H cells as p53 wildtype and showed a G1 arrest in response to irradiation. When 2 mM PTX was given prior to irradiation, it did not improve radiosensitivity of R1H cells as measured by clonogenic survival assays. CONCLUSION: PTX effectively enhances tumor oxygenation and radiosensitivity of R1H rhabdomyosarcomas, especially during continuous hyperfractionated irradiation. Given to rats as an adjuvant to fractionated irradiation, PTX does not enhance acute or late skin reactions or tumor metastasis. No radiosensitization was observed in vitro, when oxygen was not limiting. The observed radiosensitization by PTX is caused mainly by improved tumor oxygenation.

Animals↗

Oxygenation of tumor recurrences following fractionated radiotherapy of primary tumors. Studies on the rhabdomyosarcoma R1H of the rat.

BACKGROUND AND PURPOSE: Tumor oxygenation is well recognized as a major factor of tumor response to radiotherapy. In this respect, a number of studies have examined the response of primary tumors, whereas little is known about the oxygenation of tumor recurrences after radiotherapy. It was the aim of this study to investigate the oxygenation of tumor recurrences after preceding irradiation of the primary tumor. MATERIAL AND METHODS: Tumor oxygenation in primary tumors and recurrences of rat rhabdomyosarcomas R1H was measured by using pO(2) probes and Eppendorf pO(2) histography. Primary tumors were irradiated at a (60)Co radiotherapy facility with a total dose of 75 Gy, given in 30 fractions over 6 weeks. Oxygenation was measured in R1H tumors before and directly after completion of irradiation. In R1H recurrences oxygenation was determined, when they reached the same size as the previously treated primary tumors (V(o) = 3.1 +/- 0.5 cm(3)). Additionally, tumor microvessel density and the intercapillary distance of tumor blood vessels were determined on histological sections using a counting grid. RESULTS: Tumor oxygenation in R1H recurrences was significantly lower when compared to primary R1H tumors. In primary tumors a median pO(2) of 17 +/- 7 mmHg was measured. By contrast, the median pO(2) in R1H recurrences was only 5 +/- 5 mmHg (p < 0.05). The high frequency of pO(2) values < 5 mmHg indicated that R1H recurrences were significantly more hypoxic (58 +/- 5%) in comparison to primary tumors (22 +/- 4%). The histological sections of the R1H recurrences showed a higher heterogeneity in their tissue structure than primary nonirradiated tumors. The morphometric studies demonstrated a reduced microvessel density (91 +/- 21/9.04 mm(2) in the tumor periphery; p = 0.0001) compared with recurrent tumors (68 +/- 26) and an enhanced mean distance of tumor blood vessels, especially in the center of the R1H recurrences (184 +/- 20 vs. 243 +/- 70 mm; p = 0.0001). CONCLUSION: In R1H rhabdomyosarcomas tumor oxygenation in recurrent tumors following radiation therapy is significantly lower than in primary tumors. This observation has to be taken into account in cases of tumor recurrences where repeated radiotherapy, chemotherapy or combined treatment modalities are used.

Animals↗

Embryonal rhabdomyosarcoma of the orbit in a liver transplant recipient.

Although an increased incidence of de novo malignancies is reported in transplant recipients, rhabdomyosarcoma, an aggressive mesenchymal tumor typical of childhood, is not considered a neoplasm commonly related to immunosuppression. A 21-year-old woman presented with unilateral diplopia and proptosis 16 months after liver transplantation for fulminant hepatic failure. A tumoral mass originating from the medial rectus muscle was partially removed and diagnosed as being an embryonal rhabdomyosarcoma. Since the patient refused complete orbital excision, one course of radiotherapy and six courses of chemotherapy were administered, while immunosuppression was re-modulated, without interruption of the administration of cyclosporine. Complete control of tumor growth was achieved, while no alterations of graft function were observed throughout the treatment period.

Adult↗

Embryonal rhabdomyosarcoma of foot with expansive growth between metatarsals.

The case of a 14-year-old girl with rhabdomyosarcoma of the right foot is reported. Plain radiography showed a large nonspecific soft tissue tumor between the metatarsals with bowing of the metatarsals away from the mass. MR imaging showed a large soft tissue mass involving the metatarsals. The findings were conflicting, because the tumor had an infiltrative soft tissue mass and bowing of the metatarsals more suggestive of slow expansive growth. Bowing of short tubular bones may be a process similar to cortical saucerization, which is typically seen in Ewing's sarcoma, and it can be one of the findings of high grade neoplasms, such as embryonal rhabdomyosarcoma.

Adolescent↗

Massive disseminated intravascular coagulation and hyperfibrinolysis in alveolar rhabdomyosarcoma: case report and review of the literature.

A 68-year-old woman presented with profuse hemorrhage and other signs suggesting an acute leukemia. Histologic and cytogenetic evaluation of her bone marrow revealed alveolar rhabdomyosarcoma as the underlying cause of massive disseminated intravascular coagulation and hyperfibrinolysis. A review of the literature reveals that coagulopathy appears to be a common feature of alveolar rhabdomyosarcoma.

Aged↗

[Pathology of childhood and adolescent rhabdomyosarcoma].

Rhabdomyosarcoma (RMS) is the most important and a very heterogeneous group of malignant soft tissue tumors of childhood and adolescence. The two major subtypes (embryonal and alveolar) share a common myogenic differentiation, but seem to be histogenetically not related. The so-called 'International Classification of Rhabdomyosarcoma' includes, besides the two major subtypes, the botryoid and leiomyomatous subtypes of embryonal RMS which are associated with a better prognosis and are treated less aggressively according to current protocols. In addition, the solid variant of alveolar RMS is included in the alveolar group of RMS. The identification of the various subtypes is necessary and important because the treatment with the current protocols is also related to histology. Using conventional stains and immunohistochemistry, these subtypes are distinguishable. Genetic analysis can be helpful in the demonstration of t(2;13) or t(1;13) translocations in alveolar RMS. The identification of alveolar RMS with t(1;13) translocation might become important in the future, because this type of translocation seems to be related to a better prognosis as compared to tumors with a t(2;13) translocation.

Adolescent↗