Bronchioloalveolar Carcinoma in a Juvenile Rhadomyosarcoma Patient
An 11-year-old female was referred to our care for the treatment of a pathologic fracture of the lumbar spine. One month prior, she had fallen during exercise, causing persistent back pain. When symptoms failed to abate, computed tomography (CT) of the spine was performed, revealing a fracture at the L-2 level that was most likely pathologic. Given the circumstances, she was admitted to Seoul St. Mary's Hospital as a pediatric hematology patient. A chest X-ray () revealed a left lower lobe infiltrate with pleural effusion, and the chest CT revealed bilateral pleural effusions with multiple, diffuse nodules of both lungs. Positron emission tomography (PET)-CT further disclosed whole-body tumor involvement. Biopsies of the bone marrow and the sole of the right foot confirmed stage IV rhabdomyosarcoma. After 5 months of chemotherapy, a complete metabolic response was evident by PET-CT; and after 11 months of treatment, the lung lesions and pleural effusions had essentially resolved. However, two nodules persisted in the left lung-one in the upper lobe and the other in the superior segment of the lower lobe (). For diagnostic and curative purposes, wedge resection of these two nodules was performed via mini-thoracotomy. The patient's recovery was uneventful, and she was discharged on postoperative day 6.\nGrossly, the resected nodules were firm and ovoid, measuring 3 mm in diameter. In histologic sections, tumor proliferation was lepidic, marked by cuboidal to columnar cells with scanty cytoplasm following alveolar contours. Thus, bronchioloalveolar carcinoma (BAC), non-mucinous type () was diagnosed. The patient was tumor-free after 6 months, but a new mass developed on her left wrist 10 months postoperatively. Whole-body recurrence of rhabdomyosarcoma was subsequently verified by PET-CT.