Rhabdomyosarcoma is the most common soft tissue malignancy of childhood; however, can be seen very rarelyin the neonatal period also. It may arise anywhere in the body; head and neck, and genitourinary regions beingthe most frequent sites. Truncal and gluteal rhabdomyosarcoma is relatively rare occurrence. We report aneonate with embryonal rhabdomyosarcoma arising from the gluteal muscles at birth. Ultrasonography andMagnetic resonance imaging raised the possibility of hemangioma lymhangioma. Total excision was done andchemotherapy given. The child had a recurrence after 6 months where the nodule along with the scar wasexcised. A chemoport was introduced and the child underwent further 4 cycles of chemotherapy afterrecurrence. He is well on 2 years follow up without any disability

Agarwal, Prakash

Bagdi, R K

Raghupathi, V

English

Atharva Scientific Publications (E-Jounals)

 Atharva Scientific Publications 
 
 
Indian Journal of Child Health 
A quarterly, peer-reviewed, international, open access journal 
 published by Atharva Scientific Publications, India. 
Gluteal rhabdomyosarcoma in a newborn – A case 
report 
Prakash Agarwal, R K Bagdi, V. Raghupathi* 
Department of Pediatric Surgery and *Department of Pediatrics, Apollo Children’s Hospital, Chennai, India 
 
 
 
 
 
 
 
 
 
 
 
 
 
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How to cite this article: Agarwal P, Bagdi RK, Raghupathi V. Gluteal rhabdomyosarcoma in a 
newborn – A case report. Indian J Child Health. 2014;1(1):12-14. 
Case Report 
Agarwal et al       Gluteal rhabdomyosarcoma 
Indian J Child Health | Vol. 1 | Issue 1 | April – June 2014  12 
Case Report 
Gluteal rhabdomyosarcoma in a newborn – A case report 
Prakash Agarwal, R K Bagdi, V Raghupathi* 
From Department of Pediatric Surgery and *Pediatrics, Apollo Children’s Hospital, Chennai, India 
Correspondence to: Dr Prakash Agarwal, F-31 H block, Jains Avantika Apartments, Manapakkam, Chennai-
600116, India. E-mail: agarwal_prakash@hotmail.com 
Received – 02 April 2014           Initial Review – 19 April 2014           Published Online – 06 may 2014 
___________________________________________________________________________ 
ABSTRACT 
Rhabdomyosarcoma is the most common soft tissue malignancy of childhood; however, can be seen very rarely 
in the neonatal period also. It may arise anywhere in the body; head and neck, and genitourinary regions being 
the most frequent sites. Truncal and gluteal rhabdomyosarcoma is relatively rare occurrence. We report a 
neonate with embryonal rhabdomyosarcoma arising from the gluteal muscles at birth. Ultrasonography and 
Magnetic resonance imaging raised the possibility of hemangioma lymhangioma. Total excision was done and 
chemotherapy given. The child had a recurrence after 6 months where the nodule along with the scar was 
excised. A chemoport was introduced and the child underwent further 4 cycles of chemotherapy after 
recurrence. He is well on 2 years follow up without any disability. 
Key words: Embryonal rhabdomyosarcoma, Newborn, Gluteal region 
habdomyosarcoma (RMS) is a soft tissue 
tumor originating from immature 
mesenchymal cells, and account for about 
one-half of soft tissue sarcomas in children, but is 
very rare in neonates and little is known about it in 
this age group [1-6]. Embryonal RMS belongs to 
the class of small round blue cell tumors. The 
Embryonal RMS make up about 60‐70% of RMS 
cases [6,7]. RMS may be present at birth, 1‐2% of 
all cases are congenital with intrauterine origin [8]; 
neonatal tumors can be diagnosed at birth or in the 
first 28 days. There is no racial predilection; the 
tumor is slightly more common in boys. 
Although, it may arise anywhere in the body; it 
has a predilection for the head and neck area, 
genitourinary tract and the extremities [7]. 
Approximately, one half and three‐fourths of the 
sarcomas of the extremities are alveolar [6,8] and 
occur more commonly in the leg. Gluteal region is 
a rare site for RMS. We report a neonate with 
embryonal RMS in the gluteal region at birth. 
CASE REPORT 
A newborn male baby was born to gravida II, 25-
year-old healthy mother at 40 weeks gestation by 
Lower Segment Caesarean Section. The baby was 
found to have a 3X3cms mass in the left gluteal 
region at birth. The mass was firm, spherical, fixed 
to the underlying muscles and non tender, 
measuring 3x3 centimeters. Overlying skin was 
adherent to the mass. At birth, after all preliminary 
investigations it was decided to wait and watch as 
the ultrasonography and Magnentic resonance 
imaging (MRI) had reported it to be a hemangioma 
lymphangioma complex involving subcutaneous 
muscular plane of the gluteal region [Fig.1]. Due to 
jaundice and intercurrent problems the baby was 
closely followed.  
After three weeks of observation, the mass 
suddenly started increasing in size [Fig.2] and a 
suspicion of malignant teratoma was thought off 
and tumor markers e.g. AFP and Beta-HCG were 
sent, which were within normal limits. The mass 
appeared very vascular with a high flow on 
Doppler. With all preparedness, child was taken up 
for excision of the mass. At 28 days of life, total 
excision of the well encapsulated mass measuring 
6X6X5cms was performed [Fig.3]; though, it was 
adherent posteriorly to the gluteus major. Frozen 
section analysis showed malignant small round cell 
tumor. Wound was closed primarily. Specimen was 
R 
Agarwal et al       Gluteal rhabdomyosarcoma 
Indian J Child Health | Vol. 1 | Issue 1 | April – June 2014  13 
sent for HPE and Immuno-histochemical studies 
which came out to be positive for vimentin, desmin 
and myogenin and a diagnosis of Embryonal 
Rhabdomyosacoma was made [Fig.4].  
 
Figure 1 - MRI showing mass involving 
subcutaneous and muscular plane of left gluteal 
region 
 
Figure 3 - Excised specimen 
The wound healed primarily, without any 
complications. Patient was seen by pediatric 
oncologist and 3 cycles of Vincristine, 
cyclophospahmide and 1 dose of actinomycin-D 
were given at monthly intervals. At 3 months post-
operative period child was well with no recurrence 
clinically and imaging wise. After 6 months a 
nodule was found at the wound scar and a further 
wide local excision was done. Biopsy reconfirmed 
the lesion to be a recurrent rhabdomyosarcoma. A 
chemoport was inserted and further 4 cycles of 
chemotherapy was given. Now the child is 
recurrence free for the last 2 years. 
DISCUSSION 
Rhabdomyosarcoma (RMS), a malignant tumor of 
immature mesenchymal cell origin, is the most 
common soft tissue sarcoma in the pediatric age 
group, accounting for approximately 3-5% of all 
childhood malignancies [7]. The median age at the 
time of diagnosis is five years and almost two third 
of the patients are diagnosed before the age of 10 
years [9].  
 
Figure 2 - Left gluteal mass 6 X 6 X 5 cm just 
before surgery  
 
Figure 4 - Immunohistochemistry showing 
positive vimentin 
RMS is traditionally subdivided into 
embryonal, alveolar and pleomorphic. Pleomorphic 
RMS, in contrast to embryonal and alveolar RMS, 
almost exclusively occurs in adults (median age 
sixth decade). Alveolar RMS represents about 20% 
of all RMS [10]. Embryonal RMS is the most 
common type (60-70% of all RMS) [11], and is the 
most predominant in neonates, infants and young 
children [12]. 
However, occurrence of RMS in the neonatal 
period is extremely rare and only 1-2% of all cases 
are congenital [9,13]. There are only a few reports 
about neonatal RMS in the literature [4,11]. Of 
3,217 patients registered in the Intergroup 
Rhabdomyosarcoma Study (IRS) I-IV, only 14 
were in the neonatal period at the time of diagnosis 
[14]. In a report from the Italian Cooperative 
Group, among 50 infants with RMS over 20 years, 
15 were considered as having congenital RMS [13]. 
Agarwal et al       Gluteal rhabdomyosarcoma 
Indian J Child Health | Vol. 1 | Issue 1 | April – June 2014  14 
Rodriguez et al reported only four patients with 
neonatal RMS treated during 37 years (1962-1999) 
of study period [3]. Thus, knowledge about RMS in 
this age group is sparse [4].  
In congenital RMS, the disease may be 
metastatic at the time of birth with metastases in a 
number of organs and in the placenta too [15]. Age 
of the patient, location of the tumor, 
histopathologic features and metastatic status are 
the important prognostic factors for RMS [16]. 
Treatment of neonatal RMS requires a 
multidisciplinary approach involving paediatric 
oncologists, radiologists, paediatric surgeons and 
pathologists [12]. Surgery and chemotherapy is the 
mainstay of the management of these cases and 
both have their own specific role. Complete 
resection of rhabdomyosarcoma is recommended. 
Embryonal RMS generally responds very well to 
chemotherapy. However, a prolonged follow-up is 
necessary to evaluate the outcome of treatment. 
Good response to chemotherapy allows surgery to 
be done less aggressively if needed. The use of 
radiotherapy is restricted by very high risk of side 
effects and it should be avoided in newborns [7].  
CONCLUSION 
In a newborn presenting with a gluteal mass, RMS 
should be considered as one of the differential 
diagnosis as by early and appropriate institution of 
chemotherapy and surgery, these respond well.  
ACKNOWLEDGEMENT 
We thank Dr K Sridhar, Plastic Surgeon; Dr N Sekar, 
Vascular Surgeon; Dr K Raghavendran, 
Anaesthesiologist; Dr Asok Parameswaran, Pathologist; 
and Dr T Raja, Oncologist in managing this baby. 
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Funding: None; Conflict of Interest: None Stated 
How to cite this article: Agarwal P, Bagdi RK, 
Raghupathi V. Gluteal rhabdomyosarcoma in a 
newborn – A case report. Indian J Child Health. 
2014;1(1):12-14. 


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