Known monster, unknown “avatars”: Pediatric rhabdomyosarcoma case series with uncommon presentation

Rhabdomyosarcoma (RMS) is a rare soft-tissue tumor, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates from the embryonal mesenchyme. Embryonal RMS (ERMS) and alveolar RMS are the most prevalent types. In this case series, five children with unusual sites of presentation of ERMS have been reported. The first case is a 6-year-old male who presented with episodes of recurrent hemoptysis for 2 months and computed tomography chest showed lung mass. The second case is a 3-year-old male, who presented with right abdominal distention and was diagnosed as a liver ERMS which is a very rare site for RMS. The third case is a 1-year-old male child who presented with isolated right inguinal lymph node swelling. The fourth case presented with recurrent admissions for respiratory distress requiring intubation and was misdiagnosed as recurrent viral infection, but on further, investigation was diagnosed as a laryngeal ERMS. Our fifth case is a 6-year-old male child who presented with infraumbilical mass, diagnosed as a retroperitoneal ERMS. The 5-year survival rate of such tumors is 70% in children with localized disease who receive combined-modality therapy. Therefore, an awareness of the typical signs and symptoms, radiological features, and histomorphological features in a case of pediatric RMS can help a physician to consider this tumors in the differential diagnoses, even at unusual sites.