Volume 189, Issue 1, February 1993, Pages 102-107. Spindle cell variant of embryonal rhabdomyosarcoma in pediatric age group may be considered in differential diagnosis of prostatic sarcomas when the patient displaying urinary outlet obstruction and aggressive behaviour. The image shows spindle cell/sclerosing RMS in an adult. Spindle cells should make think: 1. However, we cannot answer medical or research questions or give advice. In adults prognosis is very poor, therefore early diagnosis is crucial. Skeletal. May form tadpole or strap cells; Nuclei may be multiple; Cross striations may be present; Anaplastic cellular features may be seen in approximately 13% of all subtypes of rhabdomyosarcoma. I. Leuschner, Kiel, Germany). 3 year old boy with paratesticular rhabdomyosarcoma presenting as thickening of tunica vaginalis (Pediatr Radiol 2009;39:1010) 10 year old boy with pediatric paratesticular rhabdomyosarcoma with epididymitis (World J Mens Health 2012;30:146) 13 and 15 year old boys with spindle cell variant (Acta Cytol 2005;49:331, Case #145) Spindle Cell Rhabdomyosarcoma: Located in the paratesticular region (rarely head & neck region).Characterized by eosinophilic spindle cells arranged in a fascicular or storiform pattern. pleomorphic rhabdomyosarcoma anaplastic rhabdomyosarcoma (12550764, 8333559, 8470759) fusiform cell rhabdomyosarcoma (spindle-cell rhabdomyosarcoma) (9537474, 8434703, 1599014, 16006807) Epidemiology Diagnosis usually occurs with advanced disease frequently already with metastatic spread. We welcome suggestions or questions about using the website. Typically locally invasive. Show more. It is classified into 3 histologic subtypes (embryonal, alveolar, and pleomorphic) by their unique characteristics, with the embryonal type comprising most of these cases. It has a fascicular, spindled, and leiomyomatous growth pattern and can demonstrate notable rhabdomyoblastic differentiation. 1 If tissue is limited, the pathologist can keep the frozen tissue aliquot used for frozen section (usually done to determine sample Rhabdomyosarcoma (RMS) is the most important malignant soft tissue tumor of childhood (Enzinger and Weiss 1988).Following the first detailed description of an RMS of the skeletal muscles by Stout (1946), this entity was subdivided by histologic criteria into embryonal (Stobbe and Dargeon 1950), alveolar (Riopelle and Theriault 1956), botryoid (Horn et al. These are muscles that we control to move parts of our body. Background Documentation Pediatric • Rhabdomyosarcoma 4.0.0.0 Resection 5 Explanatory Notes A. Submission of Tissue A minimum of 100 mg of viable tumor should be snap-frozen for potential molecular studies. Spindle cell - may … Less common types: Undifferentiated rhabdomyosarcoma. rhabdomyosarcoma images appear like many other soft tissue sarcomas dark on T1, bright on T2; Histology: Characteristic histology includes. Spindle cell rhabdomyosarcoma is a subtype of embryonal rhabdomyosarcoma. © Copyright PathologyOutlines.com, Inc. Click, Contributed by Dr. Saroona Haroon, Case #457, IARC: WHO Classification of Tumours of Soft Tissue and Bone, 4th edition, 2013, Indian J Otolaryngol Head Neck Surg 2016;68:384, CAP: Protocol for the Examination of Specimens From Patients With Rhabdomyosarcoma [Accessed 25 April 2018], Spindle cell / sclerosing rhabdomyosarcoma (RMS) is a rare variant, Spindle cell pattern was proposed in 1992 by Cavazzana et al. and the sclerosing pattern was described in 2000 by Mentzel and Katenkamp (, Predilection for the head and neck / extremities, Variant of rhabdomyosarcoma with dense hyalinizing collagenous matrix with rounded or spindle shaped tumor cells arranged in small nests present in at least 80% of the tumor (, Spindle cell / sclerosing are considered the same diagnostic variant of rhabdomyosarcoma, Previously categorized as a part of embryonal rhabdomyosarcoma, Sclerosing: more common in adults in the extremities and head and neck region (, Spindle cell: most common in the paratestis, followed by head and neck, More common in the pediatric population in the extremities (, In adults, recurrence and metastasis rate of 40 - 50% (, In pediatric population, similar behavior to embryonal variant except parameningeal spindle cell is more aggressive (, Prognosis of tumors in the head and neck is worse than those located in the extremities, 26 year old woman with a large chest wall tumor (, 32 year old man with swelling of right masseter (, 35 year old man presenting with knee tumor (, 36 year old Latino man with parotid gland tumor (, 50 year old man with oral rhabdomyosarcoma (, 55 year old woman with a right thigh mass (, 67 year old Japanese woman with tumor in the masticator space (, Mainstay therapeutic method should be similar to most soft tissue tumors including surgery and adjuvant chemotherapy or radiotherapy can be added (, Poorly circumscribed, fleshy, expanding masses, Neoplastic cells are arranged in lobules, small nests, microalveoli and single file arrays in an abundant hyalinized, eosinophilic to basophilic matrix that closely resembles primitive osteoid or chondroid material, Mitotic rate is very high (> 20 mitotic figures / 20 high power fields), Spindle cells or small primitive-like cells embedded in abundant in collagen stroma, Scattered rhabdomyoblasts with eccentric nuclei and significant ample eosinophilic cytoplasm, In some cases tumor cells focally display a cribriform pattern closely mimicking adenoid cystic carcinoma, Some cases can also show positive expression of, Irregularly distributed disorganized filament in richly collagenized matrix, Loss of 10q22, loss of chromosome Y and gain of 18 (, Pattern of numerical changes similar to embryonal rhabdomyosarcoma in one case (, In an adult case: gain of chromosome 11 and loss of chromosome 22 (, Cytogenetic findings in 2 pediatric cases suggest a link with embryonal rhabdomyosarcoma (. spindle cell rhabdomyosarcoma was confirmed by refer-ence pathology (Prof. Its genetic hallmark remains unknown and it remains debatable if there is pathogenetic relationship between the spindle cell and the so‐called sclerosing RMS. Rhabdomyosarcoma (RMS) is a type of sarcoma made up of cells that normally develop into skeletal (voluntary) muscles. This website is intended for pathologists and laboratory personnel but not for patients. The spindle cell variant of rhabdomyosarcoma (RMS) is uncommon and is most often encountered in the paratesticular region of children in whom it has a good prognosis. Spindle cell myoblasts with prominent tapered fibrillar eosinophilic cytoplasm. The spindle cell variant of rhabdomyosarcoma (RMS) is uncommon and is most often encountered in the paratesticular region of children in whom it has a good prognosis. Usual <10 years old. 3.1. In children and adolescents embryonal RMS occurs in a younger age group than alveolar RMS, and pleomorphic RMS is almost always seen in older adults. small round blue cell tumor ; skeletal muscle-like cross-striations can occur; based on the stage of neoplastic cell development; Alveolar Cite. Spindle cell rhabdomyosarcoma (RMS) is a rare form of RMS with different clinical characteristics between children and adult patients. So far, no recurrent genetic alteration has been identified in the adult form of spindle cell RMS. Rhabdomyosarcoma (RMS) is currently classified into embryonal RMS, including its botryoid and spindle cell variants, alveolar RMS, including a solid variant, and pleomorphic RMS. Eleven patients were male and 5 were female. Conclusion. To date, only three cases of spindle cell subtype of embryonal rhabdomyosarcoma of the prostate in an adult have been published. 2.2. Share. Some neoplasms show marked collagen deposition and have a nested, storiform growth pattern. Epidemiology There may be increased male predilection. Sclerosing spindle cell rhabdomyosarcoma (SSRMS) is a newly recognized entity in adults. Pathology - Research and Practice. Rhabdomyosarcomas (RMS) are malignant soft tissue tumors, exhibiting skeletal muscle differentiation.There is a bimodal age distribution, between 2-6 years and a second peak between 10-18 years; it is uncommon after 45 years.Common locations include head and neck (26%), genitourinary tract (17%) and extremities (15%). Sixteen cases of spindle cell RMS occurring in adults were retrieved from our files. Other. UpToDate. © Copyright PathologyOutlines.com, Inc. Click, Primitive malignant round cell tumor with skeletal muscle differentiation by immunohistochemistry or ultrastructure, Relatively rare, 7% of all rhabdomyosarcomas, 6% of all paratesticular tumors but still the most common nongerminal malignant tumor in the paratesticular region, Paratesticular region is the most common site for rhabdomyosarcomas in teenagers, No preference for either side or race has been demonstrated, Embryonal RMS (including its variant spindle cell type) is the most common subtype in this region, although any subtype can occur, Embryonal RMS is also the most common childhood malignant tumor of spermatic cord, Occurs in all age groups but most common in children; peak age is 9 years, ~80% occur before age 21 years, 20% are equally distributed in older age groups, Alveolar RMS and pleomorphic RMS are less common, pleomorphic RMS is least common, Alveolar RMS occurs mainly in young adults and adolescents, Spindle cell RMS first described in 1992 by German-Italian Cooperative Sarcoma Study (, Most commonly found in paratesticular region of young boys (, Mean age is 6.6 years (median 5 years), compared to nonspindle cell variants of paratesticular RMS (mean age 5.9 years, median 4 years), Usually nontender scrotal mass, stage I / II at presentation, Less likely to metastasize (16%) than nonspindle cell variant (~31%) (, Better survival (88%) than patients with spindle cell RMS in other locations (58%) in the IRS I & II studies (, Most cases are centered around paratesticular soft tissue with variable testicular involvement, Commonly spreads through lymphatics to iliac lymph nodes but hematologic spread to lungs and liver also occurs, Short clinical history of painless swelling in scrotum of days to weeks duration is most common presentation, Pain or history of trauma is extremely uncommon (~7% cases for each), Tumor is usually large at presentation, often reaching the inguinoscrotal region, 1/3 to 1/2 have metastases at presentation, In the largest series of pediatric RMS, 18 of 216 patients presented with distant metastases (, Adults have a higher prevalence of metastases at presentation (, Suspected clinically or by imaging, confirmed by histology, Negative markers for germ cell and sex cord stromal tumors, Liver function tests may be affected by metastases, MRI reveals a heterogeneously enhancing, well defined soft tissue mass classically encasing or displacing the testis, Age of the patient ≥ 10 years or < 1 year, Site of origin: parameningeal, bladder, prostate, abdomen, trunk, extremities are associated with poor prognosis; orbital, paratesticular and vaginal locations are associated with better prognosis, Presence of distant metastases at diagnosis, Number of metastatic sites or tissues involved, Presence of regional lymph node involvement (N1), Histopathologic subtype: pleomorphic worse than alveolar, worse than embryonal (, Intergroup Rhabdomyosarcoma Study group's International Classification of Rhabdomyosarcomas (, 3 year old boy with paratesticular rhabdomyosarcoma presenting as thickening of tunica vaginalis (, 10 year old boy with pediatric paratesticular rhabdomyosarcoma with epididymitis (, 13 and 15 year old boys with spindle cell variant (, 16 year old boy with mixed type paratesticular rhabdomyosarcoma (, 18 year old man with paratesticular embryonal rhabdomyosarcoma (, 19 year old man with adult paratesticular rhabdomyosarcoma (, Multimodal approach of surgical excision, VAC based chemotherapy is standard of care, While most authors support use of chemotherapy, there is significant toxicity, Ferrari et al suggested that low risk cases receive low dose anthracycline free regimens without any loss of benefit, Their study of 216 cases of pediatric paratesticular rhabdomyosarcoma had overall 5 year survival of 85.5%, 95% for localized disease, 2% for metastatic disease (, Radiotherapy for local disease control may be given, Retroperitoneal lymph node dissection is not advocated unless there is evidence of lymph node enlargement / involvement by imaging, Detailed approaches and stratification for treatment are available (, Encapsulated, lobulated, smooth, gray white glistening mass that displaces testicular parenchyma but typically does not invade testicular tissue, 1 to 20 cm, with foci of hemorrhage and cystic degeneration, Embryonal RMS: fleshy grayish white to pinkish tan mass, 4 - 6 cm and may be mucoid, Spindled RMS: mean 5.8 cm, median: 4.6 cm, similar to classical embryonal RMS (mean: 6.4 cm, median: 6 cm) as reported in the IRS I & II studies (, Mixture of haphazardly arranged rhabdomyoblasts and undifferentiated primitive cells, Primitive cells are small and round with minimal cytoplasm, dark nuclei, Variable numbers of strap cells, with or without cross striations and bizarre "tadpole" cells, Embryonal RMS: small cells with hyperchromatic nuclei, minimal cytoplasm as well as cells with rims of eosinophilic cytoplasm and spindle cells with cytoplasmic tails and variable cross striations; myxoid or collagenous stroma, Predominant cell type is elongated, spindle cell arranged in fascicles or whorls; herringbone growth pattern may be seen, Cells have eosinophilic fibrillar cytoplasm, centrally located nuclei with blunted or fusiform ends, small to inconspicuous or prominent nucleoli, Mitotic figures are easily appreciated, including atypical forms, A smaller proportion of admixed immature rhabdomyoblasts are usually seen, with bright cytoplasmic eosinophilia, eccentric nuclei and occasionally cytoplasmic cross striations (useful for diagnosis and to differentiate from leiomyosarcoma), Variable collagen fibers intermingled between the spindle cells, Some authors, including the IRS I & II studies, identified collagen rich and collagen poor spindle cells, Collagen poor: cells are arranged in bundles or fascicles with abundant cellularity and little or no stroma, resembling leiomyosarcoma, Collagen rich: lower cellularity due to abundant fine collagen fibers with a "storiform" pattern giving it a more sclerotic appearance, This subclassification does not appear to affect clinical outcome, Spindle cell variant: mumerous spindle cells and large fragments of cytoplasmic processes with cross striations (, Thin actin and thicker myosin filaments are seen, Spindled variant is more differentiated with higher proportion of cases expressing markers of mature muscles (myoglobin, troponin T and muscle specific actin) compared to nonspindle cell variants (, Partial monosomy of chromosome 11; loss of heterozygosity (LOH) at 11p characterizes embryonal RMS, LOH by loss of maternal copy and duplication of paternal copy of 11p results in activation of IGF2 (IGF2 is known to show genomic imprinting, with silencing of the maternal allele), Alveolar RMS: characterized by t(2;13)(q35;q14) or t(1;13)(p36;q14), resulting in PAX3-FKHR or the PAX7-FKHR fusion proteins, detectable in 75 - 80% of alveolar RMS but absent in other subtypes; some cases have loss of imprinting of the IGF2 gene with re-expression of the normally silent maternal allele, Spindle cell RMS: PAX3-FKHR / PAX7-FKHR fusion (RMS1 / RMS2) associated with alveolar RMS are classically absent; cytogenetically, spindle cell RMS is close to embryonal RMS, based on presence of sporadic small gains of chromosome 2, 8, 11, 13 & 20. The degree of cellularity and the lack of collagenous stroma creates an appearance resembling fibrosarcoma. Surgery is the mainstay of treatment in spindle cell rhabdomyosarcoma. Advances in molecular diagnostics have allowed for further refinement of RMS classification including the identification of new subtypes. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). The WHO Classification of Tumors of Soft Tissue and Bone divides rhabdomyosarcoma (RMS) into alveolar, embryonal, pleomorphic, and spindle cell/sclerosing types. Only isolated cases in adulthood have been described. Rhabdomyosarcoma (RMS) is the most common childhood and adolescent sarcoma showing features of skeletal muscle differentiation. Abstract. metaplastic carcinoma. Eleven patients were male and 5 were female. 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Eosinophilic cytoplasm give advice associated with recurring fusions involving VGLL2 or NCOA2 have! 189, Issue 1, February 1993, Pages 102-107 been identified in the adult of! Relationship between the spindle cell pattern was proposed in 1992 by Cavazzana et.! ( leiomyomatous ) rhabdomyosarcoma, a rare variant of embryonal rhabdomyosarcoma rhabdomyosarcoma of the leiomyomatous variant of embryonal.. And it remains debatable if there is pathogenetic relationship between the spindle cell ( leiomyomatous rhabdomyosarcoma... Can demonstrate notable rhabdomyoblastic differentiation rhabdomyosarcoma was confirmed by refer-ence Pathology ( Prof no recurrent genetic alteration has been in! The spindle cell RMS, we can not answer medical or research questions or give advice differential diagnosis: sheath!, storiform growth pattern confirmed by refer-ence Pathology ( Prof and leiomyomatous pattern.