1. NAME THAT GROWTH! Joel Thompson, MSIII

2. A (Brief) History 3 yo Male with a lump on his right calf discovered by his mother 3 yo Male with a lump on his right calf discovered by his mother Differential? Differential? Hematoma (traumatic)Hematoma (traumatic) InfectiousInfectious NeoplasticNeoplastic

3. 16.8 mm x 8.6 mm x 33.3 mm T1 Axial T2 Axial STIR Sag

4. The Answer is… Alveolar rhabdomyosarcoma Alveolar rhabdomyosarcoma Pt underwent wide excision with right femoral lymph node dissection Pt underwent wide excision with right femoral lymph node dissection Adjuvant chemo with ifosfamide/etoposide Adjuvant chemo with ifosfamide/etoposide

5. Rhabdomyosarcoma (RMS) ~ ½ of all soft tissue tumor of childhood & 3- 4% of pediatric cancers overall ~ ½ of all soft tissue tumor of childhood & 3- 4% of pediatric cancers overall Overall incidence in population <20 yo is 4.9 cases per million peopleOverall incidence in population <20 yo is 4.9 cases per million people Can present in head and neck, GU tract, or extremities Can present in head and neck, GU tract, or extremities Has been associated with neuro-fibromatosis, Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Costello syndrome Has been associated with neuro-fibromatosis, Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Costello syndrome Histologic types include embyronal, alveolar, anaplastic, and undifferentiated Histologic types include embyronal, alveolar, anaplastic, and undifferentiated Okcu MF et. al. “Rhabdomyosarcoma and undifferentiated sarcoma in childhood and adolescence.” Uptodate.com. Accessed November 5, 2008.

6. Rhabdomyosarcoma Imaging Imaging Plain films and CT of affected and surrounding areasPlain films and CT of affected and surrounding areas MRI is becoming imaging study of choice because of “ability to attenuate bone artifact and superior soft tissue contrast”MRI is becoming imaging study of choice because of “ability to attenuate bone artifact and superior soft tissue contrast” Basic metastatic work-up should include chest CT and bone scanBasic metastatic work-up should include chest CT and bone scan Investigate positive findings on bone scan with plain film and MRI (if plain film is equivical)Investigate positive findings on bone scan with plain film and MRI (if plain film is equivical) Okcu MF et. al. “Rhabdomyosarcoma and undifferentiated sarcoma in childhood and adolescence.” Uptodate.com. Accessed November 5, 2008.