Prostate embryonal rhabdomyosarcoma in adults: Case report and review of literature

Abstract

Introduction: Prostate embryonal rhabdomyosarcoma (ERMS) is a common tumour in infants and children, with a median occurrence age of 5 years, but it is rare in adults. It is characterized by a high degree of malignancy, both local rapid growth with formation of large pelvic masses, often leading to renal failure due to urethral obstruction, and systemic spread, commonly to the lungs, liver and bone. Several therapeutic approaches have been employed in the effort to treat prostate ERMS, but all of them have failed to gain a significant survival benefit in adult patients.

Case report: We report on a case of a stage IV prostate ERMS, approached with combined-modality treatment, with the administration of 5 courses of doxorubicin, ifosfamide and 2-mercaptoethane sulfonate sodium (mesna), and, subsequent radiotherapy to the prostatic bed (60 Gy/30 fxs). The patient remained free of progression of disease for about 1 year to finally experience a systemic relapse with multiple lung metastases and pleural effusion. The patient died for metastatic disease 27 months following the initial diagnosis.

Conclusion: While it remains questionable which therapeutic approach for prostate ERMS in adults is the most appropriate, our report demonstrates that a chemo-radiation combined treatment can control the prostate disease, reducing the symptoms and improving the quality of life of these patients, for the most part destined to die for systemic progression of disease.

Keywords: Adults; Embrional; Prostate cancer; Radiation therapy; Rhabdomyosarcoma.

Fig. 1

Total body TC at diagnosis: massive enlargement of prostate gland and multiple nodules in both lungs.

Fig. 2

CT/PET scan at diagnosis: prostate and bilateral lung pathological uptake.

Fig. 3

Pelvic CT scan 6 months after radiotherapy completion: reduction of prostate mass.

Fig. 4

Total body CT scan at moment of progression disease: appearance of multiple nodules in bilateral lung and large bilateral pleural effusion and diffuse pulmonary lymphangitis carcinomatosa.