EMBRYONIC RHABDOMYOSSARCOMA OF THE HEAD AND NECK IN AN 18-YEAR-OLD PATIENT: A CASE REPORT

• DOI: https://doi.org/10.22533/at.ed.1594362410044

• Palavras-chave: Head and neck neoplasms; Embryonic rhabdomyosarcoma; Combination therapy.

• Keywords: Head and neck neoplasms; Embryonic rhabdomyosarcoma; Combination therapy.

• Abstract:

  Introduction: Embryonic rhabdomyosarcoma is a rare malignant tumor, more prevalent in the pediatric age group, mainly in the head and neck region. Therapeutic planning depends on the location of the tumor, extent of the disease and the presence or absence of metastases. We present the case of an 18-year-old patient who came to the Pernambuco Cancer Hospital due to a large lesion on the left hemiface, with deviation of the contralateral hemiface, of rapid and progressive growth, which began 5 months ago. The patient also reports local pain, epistaxis, dysphagia, odynophagia and postprandial emetic episodes. Magnetic resonance imaging revealed an expansive and infiltrative lesion, with its epicenter in the left maxillary antrum, measuring approximately 5.9 x 5.2 x 4.6 cm in its largest anteroposterior, transverse and longitudinal diameters, respectively. The immunohistochemical study of the lesion concluded that it was an embryonal rhabdomyosarcoma. The patient was considered out of surgical treatment, starting chemotherapy treatment with a regimen of vincristine, doxorubicin and cyclophosphamide, associated with Granulokine, obtaining a positive response after two cycles of chemotherapy. On facial computed tomography, a decrease in the anteroposterior diameter of the tumor to 5.0 cm was observed. The patient continues with seven cycles of chemotherapy, showing an excellent response to treatment, with improvement in the symptoms reported at the first consultation and satisfactory gradual weight gain. She is awaiting the next appointment with clinical oncology to evaluate the possibility of starting adjuvant radiotherapy for local control. Objective: Report a case of an 18-year-old patient with embryonal rhabdomyosarcoma. Methodology: A literature review of the topic was carried out in the PUBMED and SCIELO database and analysis of 01 case in medical records. Results and discussion: Rhabdomyosarcomas are considered rare in patients aged 15 to 19 years, with the embryonic subtype being the least prevalent in this age group. Treatment is multimodal, with complete surgical resection of the lesion associated with adjuvant chemotherapy to control micrometastases being the therapeutic line of choice. In the case reported, it was impossible to completely resect the lesion due to the extent of the disease and chemotherapy was chosen as the initial treatment, associated with future adjuvant radiotherapy for local control and then reevaluation for surgical treatment, this last item being the goal of the patient's current therapeutic plan. Conclusion: Embryonic rhabdomyosarcoma is a rare tumor, especially among young adults, and must be managed by a multidisciplinary team for greater therapeutic efficacy.