A Progressive Embryonal Rhabdomyosarcoma of the Uterine Cervix With Right Breast Lump in a 43-Year-Old Adult: A Case Report

Introduction: Embryonal Rhabdomyosarcoma is an uncommon type of sarcoma often seen in pediatric and adolescent patients, with the botryoid subtype being the most common. The incidence of this disease in adult females is 0.4% to 1% with the affected age group being patients in the third to fourth decade of life. It is rare in patients above 40 years in Nigeria. Case Presentation: We describe the case of a 43-year-old, para 4+1, 4 alive, premenopausal female health worker, with an ECOG performance status of 1, who presented with a protruding cauliflower, exophytic cervical polyp extending to the lower one-third of the vagina of eight months duration. Post-polypectomy histology revealed a huge, highly vascularized mass, with high histologic grade, and some cartilaginous components. Based on financial limitations and out-of-pocket payments, the patient could not afford standard concurrent chemo-radiation post-surgery. Adjuvant chemotherapy with intravenous (IV) Vincristine 2mg Day 1, Doxorubicin 100mg Day 1, and Cyclophosphamide 1000mg D1 (VAC) regimen, 3 weekly for 6 courses, was offered to the patient. However, a partial response after the third course was noticed, with an incidental finding of a right breast mass noted. A modified regimen with the addition of IV Dacarbazine 1500mg on Day 1 was given due to poor response and tumour recurrence. Total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) was done, and immunohistochemistry for Desmin was strongly positive. The patient's performance status remains the same while further evaluation of the right breast is being carried out. She has been counseled to undergo radiotherapy as soon as possible. We discuss the disease in general, pathologic features of the disease, epidemiology, presentation patterns with prognostic factors, management modalities with consideration of standard radiation therapy management, and outcomes.