J Clin Pathol Qual Control.  1998 Jun;20(1):177-186.

A Case of Rhabdomyosarcoma Involving Bone Marrow Confirmed by Immunohistochemical Staining

• Choi JW
• Hwang TS
• Pai SH

Abstract

Bone marrow infiltration rarely occurs at presentation of rhabdomyosarcoma. This possibility leads to misdiagnosis of leukemia and incorrect therapies might be performed. Extensive marrow involvement of rhabdomyosarcoma is rare and only a few cases of rhabdomyosarcoma involving bone marrow have been reported in Koreans. The authors recently experienced a case of rhabdomyosarcoma presenting with diffuse bone marrow involvement and confirmed by immunohistochemical staining method. A fifteen-year old female patient visited Inha University Hospital because of bilateral enlargement of inguinal lymph nodes which was developed 2 months ago. The patient had past history of treatment for a perianal mass at a local clinic 4 months ago. In biochemical tests, LD (lactate dehydrogenase) was 2,949 ug/dL, and serum uric acid was 7.9 ug/dL. Initially, aspiration of the inguinal lymph node revealed a high possibility of malignant lymphoma, and radiologic study also suggested lymphoma or leiomyosarcoma. Peripheral blood smear frequently showed blasts and 16 nucleated red cells/100 WBCs. Bone marrow aspiration slides showed poorly differentiated, small and medium-sized blasts with multiple vacuoles of varying sizes. These blasts revealed strong positive reaction for PAS staining, but were negative for ANBE, acid phosphatase, and myeloperoxidase. Immunohistochemical staining revealed a positive reaction to anti-desmin and anti-myoglobin antibody and a negative reaction to CD45, CD68, NSE (neuron specific enolase), and chromogranin. The patient is currently being in the treatment for rhabdomyosarcoma with chemotherapeutic regimens.

MeSH Terms

Acid Phosphatase
Bone Marrow*
Diagnostic Errors
Female
Humans
Leiomyosarcoma
Leukemia
Lymph Nodes
Lymphoma
Peroxidase
Rhabdomyosarcoma*
Uric Acid
Vacuoles
Acid Phosphatase
Peroxidase
Uric Acid