Complete mimicry: a case of alveolar rhabdomyosarcoma masquerading as acute leukemia

Diagnostic Pathology
Osamu ImatakiNorimitsu Kadowaki

Abstract

A small number of rhabdomyosarcoma (RMS) cases involve the bone marrow. A leukemic presentation of RMS has been reported in a few case series, although almost all cases of leukemic RMS are not completely mimicking leukemia. We encountered a case with RMS cell infiltration of the bone marrow that resembled floating hematological cells. We encountered a rare case of a 15-year-old boy with a 2-week history of left femoral pain. Upon admission, he was afebrile with no other symptoms. No apparent cause of femoral pain was detected on an initial examination. Laboratory findings revealed normal white blood cell (WBC) count and hemoglobin concentration, with a platelet count of 10.3 × 104/μL. WBCs included 2.0% metamyelocytes, 4.5% myelocytes, and 0.5% blasts. Lactate dehydrogenase concentration was 1299 U/L, creatine kinase was 437 U/L, and C-reactive protein was 1.25 mg/dL. Bone marrow aspiration demonstrated hypercellular marrow (nucleated cell count 1.84 × 104/μL) and 89.0% of blast-like cells of all nucleated cells. The proliferating cells were negative for myeloperoxidase and esterase, and strongly positive for CD56. Positron emission tomography exhibited extensive accumulation of 18F-fludeoxyglucose with a SUVmax of 7.09. Magnet...Continue Reading

References

Sep 18, 2001·American Journal of Hematology·A A SandbergJ D Cohen
Mar 27, 2003·European Journal of Haematology·Laura McIlwainHussain I Saba
Oct 8, 2008·Pediatric Blood & Cancer·Yuichi ShinkodaJun Okamura
Aug 14, 2013·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Aaron R WeissRichard B Womer
Oct 12, 2014·International Journal of Surgical Pathology·Jason B KernAmy S Duffield
Oct 29, 2014·International Journal of Hematology·Kriti ChauhanR K Grover

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Citations

Aug 21, 2019·Clinical Case Reports·Bernardo López-AndradeAntonia Sampol
Nov 7, 2020·Indian Journal of Pathology & Microbiology·Rakhi V Jagdale, Jaydeep N Pol

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Methods Mentioned

BETA
biopsy
Flow cytometry

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