J Korean Med Sci.  2013 Mar;28(3):476-479. 10.3346/jkms.2013.28.3.476.

Embryonal Rhabdomyosarcoma Arising from a Mediastinal Teratoma: An Unusual Case Report

• Ryu YJ
• Yoo SH
• Jung MJ
• Jang S
• Cho KJ

• KMID: 1786949
• DOI: http://doi.org/10.3346/jkms.2013.28.3.476

Abstract

We report an unusual case of 9.5-cm-sized embryonal rhabdomyosarcoma arose from a mediastinal mature teratoma in a 46-yr-old man. A man presented with chest trauma as a result of an accident at 10 September 2011. On chest X-ray, an anterior mediastinal mass was detected. To obtain further information, chest computed tomography (CT) with contrast enhancement was performed, revealing an anterior mediastinal mass. Complete surgical excision was performed and entire specimen was evaluated. Pathologic diagnosis was embryonal rhabdomyosarcoma arising in mature cystic teratoma. After surgical excision, two cycles of dactinomycin-based chemotherapy were performed. Lung metastasis was detected on follow up CT in September 2012, and wedge resection was performed. Pathological finding of the lung lesion showed same feature with that of primary rhabdomyosarcoma.

Keyword

Mediastinum; Rhabdomyosarcoma; Embryonal; Teratoma

MeSH Terms

Antibiotics, Antineoplastic/therapeutic use
Dactinomycin/therapeutic use
Desmin/metabolism
Humans
Immunohistochemistry
Lung Neoplasms/radiography/secondary/surgery
Male
Mediastinal Neoplasms/*diagnosis/pathology
Middle Aged
Neoplasms, Germ Cell and Embryonal/drug therapy/*radiography/surgery
Rhabdomyosarcoma, Embryonal/drug therapy/*radiography/surgery
Teratoma/*diagnosis/pathology
Tomography, X-Ray Computed
Antibiotics, Antineoplastic
Desmin
Dactinomycin

Figure

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  Fig. 1 Radiologic and gross findings of mediastinal rhabdomyosarcoma arising in mature teratoma. (A) An anterior mediastinal mass in chest X-ray. (B) A 9.5-cm-sized anterior mediastinal mass in Chest Computed tomography. (C) 9.5-cm-sized a well-circumscribed round and firm mass, which is covered as normal thymus and peri-thymic soft tissue. (D) The cut surface of mass show flesh meat like pale tan appearance.

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  Fig. 2 Findings of microscopy and immunohistochemistry. (A) In teratoma area, mature squamous epithelium is seen. It is very close to embryonal rhabdomyosarcoma component (H&E, × 40). (B) Low power view of sarcoma area. Intermingled dense compact cellular area and loose myxoid area (H&E, × 12.5). (C) Numerous rhabdoid myoblasts. Epithelioid rhabdomyosarcoma cell showed deeply eosinophilic cytoplasm and small eccentric oval shaped nuclei (H&E, × 400). (D) Tumor cells show immunopositivity for Desmin (× 400).

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