Rare Adult-Onset Nasopharyngeal Botryoid Embryonal Rhabdomyosarcoma: A Case Report and Review of Literature

Botryoid embryonal rhabdomyosarcoma (RMSs) is a rare malignant tumor typically seen in children, with common sites including the vagina, bladder, and nasopharynx. Its occurrence in adults, is extremely rare, with a very limited number of cases in the nasopharynx. This case report highlights the unusual presentation of the disease and its treatment follow-up. A 46-year-old male presented with a painless neck mass and weight loss. Imaging revealed a parapharyngeal mass with cervical lymphadenopathy, and biopsy confirmed nasopharyngeal botryoid embryonal RMS. Due to the tumor's proximity to critical structures, surgical resection was not feasible. The patient received vincristine, actinomycin-D, and cyclophosphamide, chemotherapy followed by radiotherapy, achieving complete radiological remission. However, regional recurrence was detected three months post-treatment, necessitating a switch to ifosfamide and etoposide chemotherapy. This case highlights the challenges of diagnosing and treating adult-onset nasopharyngeal botryoid embryonal RMS, emphasizing the importance of vigilant follow-up and tailored treatment strategies. Given its rarity, this report provides valuable insights into the management of adult RMS.