Breast Metastases in Children and Adolescents with Rhabdomyosarcoma Experience of the Italian Soft Tissue Sarcoma Committee

Pediatric Hematology and Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy.
Pediatric Blood & Cancer (Impact Factor: 2.39). 12/2010; 55(7):1306-9. DOI: 10.1002/pbc.22729
Source: PubMed


Breast metastasis from rhabdomyosarcoma (RMS) is an uncommon event but may be problematic in treatment decision-making. Aim of the study was to evaluate clinical characteristics, treatment, and subsequent outcome, of patients with RMS metastasis in the breast, enrolled in four consecutive Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) Soft Tissue Sarcoma Committee protocols during the last 20 years, in order to obtain information to establish a more adequate diagnostic and therapeutic approach.
Data were derived from the AIEOP STSC database and reviewed for the purpose of this study.
From 1988 to 2008, among 189 patients with metastatic RMS, we identified 7 (3.7%) patients with RMS with breast involvement at diagnosis. All patients were females, aged 13-17 years with alveolar histology and multiple metastasis sites (2-5). The primary tumor was located in the extremities in 3/7 patients. In spite of intensive treatment no patient survived. The cause of treatment failure was distant relapse in six patients, including two on the mammary region. Treatment data analysis revealed that local measures to control breast lesions were used in only two patients.
Our data suggest that investigations of the mammary region should be part of the usual diagnostic workup in adolescent girls with alveolar RMS, especially if the primary tumor arises in the extremities. New and more effective strategies are needed to improve the outcome of these patients including aggressive local measures to control breast disease.

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Available from: Andrea Di Cataldo, Sep 18, 2014
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    • "Breast RMS is rarely primary and most often metastatic from another site. The extrammamary primary origin is usually trunk, neck, orbit, and the extremities [3]. Unfortunately, the prognosis of metastatic breast RMS is very poor and there is no consensus about the treatment of breast metastasis due to its rarity [3,4]. "
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    ABSTRACT: Rhabdomyosarcoma (RMS) of the breast is rare and there is scant information about the clinical behavior and treatment strategies. We report an adolescent female patient with metastatic RMS of the breast from the anus. An 18-year-old female patient was referred to our clinic due to palpable mass in the left breast. At age seven, she was diagnosed with acute lymphoblastic leukemia and treated with chemoradiation therapy. After 10 years of complete remission state, she presented with anal mass which was diagnosed as RMS and she received chemoradiation therapy. After 1 year of complete remission state, she noticed a palpable mass in her left breast. The breast mass was diagnosed as metastatic RMS based on core needle biopsy specimen. The RMS in breast was excised for the decreasing tumor burden despite of another metastatic lesion. Although rarely reported, metastasis of RMS should be considered as a cause of breast mass. Tissue biopsy is recommended when clinically suspected lesion is detected.
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    • "We found only four reports of19–22 similar cases with alveolar rhabdomyosarcoma of the extremities in the literature. In a series of 189 patients with metastatic rhabdomyosarcoma reported by D'Angelo from Italian Soft Tissue Sarcoma Committee there were 7 adolescent with breast involvement. "
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