Purpose NHL patients are at increased risk of the development of a secondary malignancy, typically myelodysplasia, acute leukemia, or lung cancer. To our knowledge, the development of metastatic rhabdomyosarcoma has not been reported.
Methods A 25-year-old white male previously treated for non-Hodgkin's lymphoma of the left maxillary sinus and bilateral kidneys as a child with a CHOP-based chemotherapy that excluded radiation presented to his local medical doctor with complaints of frequent nosebleeds and right-sided facial pain. At presentation, the patient was noted to have anemia and thrombocytopenia with right-sided facial fullness and bilateral scrotal swelling. He was transferred to our facility for a thorough workup, including physical examination, bone marrow aspirate, otolaryngology evaluation, and radiologic review.
Results Contrasted and noncontrasted CT scans of the head revealed ethmoid, sphenoid, right maxillary, and right mastoid sinus disease. There was also a 1.7 × 0.8 cm right nasal soft tissue density that enhanced with contrast material. Contrasted and noncontrasted CT scans of the chest, abdomen, and pelvis were revealing for a soft tissue mass overlying a fractured right-sided fourth rib. Ultrasonography of the scrotum revealed multiple hypoechoic solid nodules within both testicles that were felt to be suspicious for lymphomatous metastatic disease. Whole-body bone scan showed increased activity in the proximal half of the left humerus, right humerus, and anterior rib cage. There were also multiple foci about the right-sided facial and cranial regions. Bone marrow aspirate and biopsy were performed and were significant for embryonal rhabdomyosarcoma. This was also the same pathologic finding of the biopsied right-sided nasal mass performed by Otolaryngology.
Discussion Accompaning the success of clinically curing non-Hodgkin's lymphoma is the long-term risk for the development of a secondary malignancy. Acute nonlymphocytic leukemia has the earliest appearance and typically occurs 5 to 10 years after treatment. Solid tumors appear 15 or more years after treatment and are most often found to be lung, brain, kidney, breast, and bladder. There are multiple contributing factors that include previous antecedent therapy and host susceptibility. This presentation of metastatic rhabdomyosarcoma is not only unfortunate but rare.
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