Fetal-Type Rhabdomyoma of the Cheek: A Conservative Management

Abstract

Extracardiac rhabdomyomas are rare benign mesenchymal tumors diagnosed upon radiological and hystologic investigations and the treatment of choice is surgical exertion. There aren't any similar cases managed conservatively reported in literature as in our case, to the best of our knowledge. We present a rare case of fetal cheek rhabdomyoma diagnosed in a healthy 2 months-old boy, with asymptomatic mass over the left masseter. The lesion could not be removed, due to the size and dimensions and the young age of the patient. However, the lesion did not show signs of spreading or progression over a 36 months follow-up. Fetal rhabdomyoma is a benign tumor, often located in the head and neck district, where surgery, especially in very young children, is associated with a high risk of complications and long-term sequelae. Our case report demonstrates the possibility to manage these lesions conservatively in the first years of life with close sonographic and clinical follow-up.

Keywords: case report; child; conservative management; head; infant; rhabdomyoma; tumor.

Figure 1

Swelling of the left cheek in a 2 months-old boy.

Figure 2

Skin and subcutaneous ultrasound. A fusiform mass over the left masseter muscle, inhomogeneous and hypoechogenic, sized 17 mm × 15 mm (A). Concurrent thickening of the left sternocleidomastoid muscle at the mastoid head with increased thickness compared to the contralateral side (8 mm) (B).

Figure 3

Head and neck MRI. Examination performed before and after intravenous bolus administration of 1 ml of paramagnetic contrast medium, such as Dotarem (gadoteric acid) 0.5 mmol/mL. (A) Coronal image T2 dixon: Fusiform dilation of the left masseter muscle (20 mm × 15 mm × 21 mm) with minimal, homogeneous hyperintensity in T2 signal. Fusiform swelling at the level of the cranial slope of the left sternocleidomastoid muscle (13 mm × 14 mm × 31 mm). (B) Intravenous contrast-enhanced axial image T1 dixon: Homogeneous isointensity of the signal in T1 with no perifocal edema or pathological enhancements after contrast administration.

Figure 4

Picture of the child at 36 months follow-up, unchanged tumor size.