Perianal rhabdomyosarcoma presenting as a perirectal abscess: A report of 11 cases
Autor: | David Crawford, Alberto S. Pappo, Louis P. Dehner, Wayne L. Furman, Kenneth W. Gow, Sean M. Pflaumer, Michael B. McDermott, D. Ashley Hill, Andrea A. Hayes-Jordan |
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Rok vydání: | 2002 |
Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Anal Canal Physical examination Diagnosis Differential Rhabdomyosarcoma Incision and drainage medicine Humans Child Abscess Past medical history medicine.diagnostic_test business.industry Perianal Abscess Rectum Infant General Medicine Anus Neoplasms Anus medicine.disease Combined Modality Therapy Surgery Perineum Rectal Diseases Treatment Outcome medicine.anatomical_structure Child Preschool Pediatrics Perinatology and Child Health Female business |
Zdroj: | Journal of Pediatric Surgery. 37:576-581 |
ISSN: | 0022-3468 |
Popis: | Background Purpose: The organs and soft tissues of the pelvis are some of the most common primary sites for rhabdomyosarcoma (RMS) in children and adolescents. In most cases a mass is detectable on clinical examination, and the initial concern is focused on the possibility of a neoplasm. The current report concerns 11 patients, each presented with a painful perineal-perianal mass suggesting an abscess to the extent that each one of these patients was treated initially with antibiotics or incision and drainage for several weeks to months before the pathologic diagnosis of RMS was established. Methods: The authors reviewed the clinical histories of all patients with perirectal/perianal RMS from their respective institutions to identify cases in which the initial clinical diagnosis or impression was that of a perirectal abscess. Pathologic material was reviewed in all cases. Results: Eleven patients, 7 of whom were girls, ranged in age from 1 to 16 years at diagnosis (median age, 14 years). Fever accompanied the clinical presentation in 2 patients. None of the patients had a past medical history of illness that may have predisposed them to a perirectal abscess, although one patient had a family history of inflammatory bowel disease. Duration of symptoms ranged from 1 month to 1 year (mean, 4.6 months). Each patient presented with a tender perianal/perineal nodule or mass. Inguinal adenopathy was present in 6 patients at diagnosis. White blood cell counts ranged from 6,600/mm 3 to 24,500/mm 3 . LDH levels ranged from 414 to 3,432 U/L. The average time from presentation to pathologic diagnosis of RMS was 2.1 months. Nine of the 11 cases showed an alveolar pattern. All were high-stage disease. Of 7 patients with follow-up longer than 1 year, 2 (29%) are alive without disease. Conclusion: This report presents the need to consider the possibility of a malignant neoplasm, in this case RMS, in a child or adolescent with a putative perirectal abscess that fails to respond in the expected manner to incision and drainage and antibiotic therapy. J Pediatr Surg 37:576-581. Copyright 2002, Elsevier Science (USA). All rights reserved. |
Databáze: | OpenAIRE |
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