Alveolar rhabdomyosarcoma with placental metastasis during pregnancy
Objective To study the clinicopathological features of alveolar rhabdomyosarcoma with placental metastasis in pregnant women and its impact on pregnant women and fetuses.Methods The clinicopathological data of a case of alveolar rhabdomyosarcoma with sternoabdominal,liver and placental metastasis in the middle and late trimester of pregnancy with unknown primary site were retrospectively analyzed,and the relevant literatures were reviewed.Results The 28-year-old female patient was admitted to the hospital with menopause of 26+5 weeks,2 parturients and 1 pregnancy,abdominal distension for more than half a month and chest tightness for 3 days.Ultrasonography showed bilateral pleural effusion and abdominal effusion.The omentum was thickened and the thicker part was about 3.4 cm.MR1 showed perihilar metastasis,greater omentum thickening and splenomegaly.Ultrasound-guided puncture and drainage were performed on the right pleural cavity,followed by pathological examination and biopsy of the right anterior lobe of the liver.Because of fetal intrauterine death,the induced labor was performed with analyses of placental pathology.Microscopic pleural effusion,liver puncture and placental tissue showed small round blue cell tumor with immature differentiation.Immunohistochemistry mainly showed positive expression of myogenic markers Desmin,MyO-D1 and Myogenin.After induced labor,due to the poor general condition of the puerpera,only symptomatic treatment was given,and corresponding chemotherapy could not be given.The family members gave up treatment,and the patient died several days after discharge.Conclusion Fetal alveolar rhabdomyosarcoma with placental metastasis is rare and has a poor prognosis.In pathological diagnosis,attention should be paid to the differentiation of small cell malignant tumor.Considering the effect of treatment on pregnant women and fetus,the timing of surgery and chemotherapy should be carefully selected.
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