Introduction: Rhabdomyosarcoma is the most common soft tissue sarcoma in children; however, primary involvement of the uterine cervix is exceedingly rare, particularly in adolescents. Cervical embryonal rhabdomyosarcoma often presents as a polypoid cervical mass and may mimic benign lesions, resulting in delayed diagnosis. Recent reports have described a characteristic fan-shaped growth pattern on ultrasound, known as the “ballet tutu” sign, suggestive of cervical sarcoma. Case presentation: A 13-year-old girl presented with prolonged foul-smelling vaginal discharge, intermittent bleeding, and a mass protruding from the vaginal introitus. Transabdominal, transperineal, and transrectal ultrasound demonstrated a large heterogeneous polypoid mass arising from the cervix and protruding into the vagina. The lesion showed fan-shaped stromal infiltration from the internal cervical os, producing the characteristic “ballet tutu” appearance, along with marked intratumoral vascularity on color Doppler imaging. The patient was managed with transvaginal local excision. Histopathological examination revealed clusters of rhomboid- to spindle-shaped cells with hyperchromatic nuclei and scant cytoplasm, admixed with inflammatory cells and vascular proliferation. Immunohistochemistry was positive for desmin and myogenin, confirming the diagnosis of cervical embryonal rhabdomyosarcoma. The patient was subsequently referred to multidisciplinary oncologic care. Conclusions: Cervical embryonal rhabdomyosarcoma is an exceptionally rare malignancy in adolescents and closely resembles benign cervical polyps. Recognition of the “ballet tutu” sign combined with marked tumor vascularity on ultrasound may facilitate early suspicion and timely management of cervical sarcoma in pediatric patients.
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