International Journal of Environmental Research and Public Health Case Report Rhabdomyosarcoma of the Cervix in a Post-Menopausal Woman—An Unparalleled Phenomenon Jakub Pawlik 1,* , Weronika Pawlik 1, Dorota Branecka-Wo´zniak 2, Katarzyna Kotrych 3 and Aneta Cymbaluk-Płoska 1 1 Department of Gynecological Surgery and Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; [email protected] (W.P.); [email protected] (A.C.-P.) 2 Department of Gynecology and Reproductive Health, Pomeranian Medical University, 71-210 Szczecin, Poland; [email protected] 3 Department of General and Dental Radiology, Pomeranian Medical University, 70-111 Szczecin, Poland; [email protected] * Correspondence: [email protected] Abstract: Rhabdomyosarcoma of the cervix is a soft tissue sarcoma that usually occurs in young women. It is very rare in adulthood. We discuss symptoms, the process of diagnosis of rhabdomyosar- coma embryonale of the cervix in a 61-year-old women and differences in treatment dependent on patient’s age. A 61-year-old woman with symptoms such as palpable mass in the external cervical opening and post-menopausal hemorrhaging was admitted to the oncology ward where excision of the polyp was performed. Embryonal rhabdomyosarcoma (ERMS) was diagnosed by histopatho- logical examination of obtained tissues. The diagnosis was complemented by chest computed Citation: Pawlik, J.; Pawlik, W.; tomography and pelvis magnetic resonance imaging to exclude metastases. A Wertheim–Meigs Branecka-Wo´zniak,D.; Kotrych, K.; operation and excision of the ovaries, the fallopian tubes and the surrounding tissue was performed Cymbaluk-Płoska, A. in the course of treatment. In the patient’s follow-up of 25 months to date, there have been no signs Rhabdomyosarcoma of the Cervix in of recurrence or symptoms connected to ERMS. Based on the therapeutic outcome, the decision to a Post-Menopausal Woman—An limit the treatment to a surgical resection was adequate for a post-menopausal patient. Because of the Unparalleled Phenomenon. Int. J. Environ. Res. Public Health 2021, 18, rarity of ERMS in the post-menopausal age, we think that the patient should be carefully followed 7851. https://doi.org/10.3390/ up to further examine this issue and develop diagnostic and treatment guidelines. ijerph18157851 Keywords: rhabdomyosarcoma; sarcoma; cervix; uterus; oncology; gynecology; neoplasm; Academic Editor: Paul B. Tchounwou post-menopausal Received: 30 June 2021 Accepted: 23 July 2021 Published: 24 July 2021 1. Introduction Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and Publisher’s Note: MDPI stays neutral adolescents [1]. It mostly occurs in patients up to 4 years old, with approximately 4 cases with regard to jurisdictional claims in per 1 million children, with a lower rate in adolescents. Soft tissue sarcomas are gen- published maps and institutional affil- erally unusual and unsuspected in the adult population, especially in the more mature iations. age [2]. The most common types of soft tissue sarcoma in post-menopausal patients are: leyomiosarcoma (mostly seen in the abdomen and the uterus), fibrohistiocytic sarcoma (mostly seen in upper and lower extremities) and liposarcoma (mostly seen in the lower extremities), accounting for 19–26%, 20–25% and 12–17% of all sarcomas in these age Copyright: © 2021 by the authors. groups, respectively [3,4]. In adults, sarcomas account only for 8% of all uterine neoplasms. Licensee MDPI, Basel, Switzerland. They usually yield a more aggressive clinical course and lower survival rate compared to This article is an open access article other types of uterine malignancies, such as endometrial carcinoma [5]. distributed under the terms and Rhabdomyosarcoma develops from embryonic mesenchymal cells which also differen- conditions of the Creative Commons tiate into striated muscle cells [6]. It typically develops in the head and neck (approximately Attribution (CC BY) license (https:// 25%) and the genitourinary tract area (approximately 31%). The World Health Organisation creativecommons.org/licenses/by/ 4.0/). divides RMH into four types, embryonal, alveolar, pleomorphic and spindle cell/sclerosing, Int. J. Environ. Res. Public Health 2021, 18, 7851. https://doi.org/10.3390/ijerph18157851 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 7851 2 of 8 Int. J. Environ. Res. Public Health 2021, 18, x 2 of 8 with embryonal being the most common type [7]. The pathophysiology of rhabdomyosar- rhabdomyosarcomas still remains unclear; recent studies have shown DICER1 somatic or comas still remains unclear; recent studies have shown DICER1 somatic or germ-line germ-line mutations to occur in a majority of genitourinary tract ERMS [8]. mutations to occur in a majority of genitourinary tract ERMS [8]. Cervical ERMS is extremely rare and there are only a few cases published in the Eng- Cervical ERMS is extremely rare and there are only a few cases published in the English lish literature describing the management and treatment of this disease in adult women literature describing the management and treatment of this disease in adult women [9–12]. [9–12]. We report a case of a 61-year-old women with rhabdomyosarcoma embryonale of We report a case of a 61-year-old women with rhabdomyosarcoma embryonale of the cervix the cervix initially presenting itself as a cervical polyp. The aim of our paper is to increase initially presenting itself as a cervical polyp. The aim of our paper is to increase awareness ofawareness such a rare of neoplasmsuch a rare and neoplasm explain theand process explain of the diagnosis. process of Most diagnosis. of all, we Most see theof all, need we tosee discuss the need the to available discuss treatment the available options treatmen and assesst options how and to determineassess how the to best determine approach the whilebest approach dealing with while various dealing types with of various patients. types of patients. 2.2. CaseCase ReportReport AA 61-year-old61-year-old woman, woman, gravida gravida 3 3 para para 3, 3, last last menstruation menstruation at at 54 54 years years of of age, age, reported reported toto herher gynecologistgynecologist complainingcomplaining about irre irregulargular post-menopausal post-menopausal hemorrhaging hemorrhaging and and a amass mass emerging emerging from from the the external external cervical cervical opening opening she shepalpated. palpated. She presented She presented no other no othersymptoms symptoms or complaints, or complaints, including including no pain no whatsoever. pain whatsoever. Her gynecologist Her gynecologist referred referred her to herthe toObstetrics the Obstetrics and Gynecology and Gynecology Clinics Clinics emerge emergencyncy room. room.On admittance, On admittance, physical physical exami- examinationnation revealed revealed no irregularities no irregularities apart apartfrom a from solid a palpable solid palpable mass in mass the incervix. the cervix.A pre- Aoperative pre-operative imaging imaging was performed, was performed, in this incase this an case ultrasound an ultrasound examination, examination, using a using trans- avaginal transvaginal probe, probe,that confirmed that confirmed the presence the presence of a 5.5 of cm a 5.5 polyp cm polypthat expanded that expanded the cervix. the cervix.Moreover, Moreover, the patient the patient suffered suffered from stage from stage2 arte 2rial arterial hypertension hypertension and class and class3 obesity 3 obesity (BMI (BMI= 40), = and 40) ,had and undergone had undergone a single a singlesurgery surgery in the inpast, the an past, open an appendectomy. open appendectomy. Her mother Her mothersuffered suffered from a neoplasm from a neoplasm (most likely (most pancreat likelyic pancreatic cancer); there cancer); were there no other were diseases no other in diseasesthe family in thehistory. family history. TheThe patientpatient underwent a surgical surgical procedure procedure of of excising excising the the polyp polyp at atits itspeduncle peduncle us- usinging a aLEEP LEEP loop loop electrode. electrode. It It could could not not be be removed in oneone piece—thepiece—the polyppolypfragmented fragmented intointo several several pieces pieces during during extraction. extraction. Then,Then, aa curettagecurettage ofof the the cervix cervix and and an an unsuccessful unsuccessful attemptattempt of of a a uterine uterine cavity cavity curettage curettage was was performed. performed. Obtained Obtained tissues tissues were were then then sent sent to the to pathologythe pathology department department for a histopathologicalfor a histopathological examination. examination. The findings The findings were ready were inready six weeksin six weeks after the after procedure the procedure and revealed and revealed the presence the presence of rhabdomyosarcoma of rhabdomyosarcoma embryonale embry- (typeonale botryoides) (type botryoides) in the in excised the excised polyp. polyp. Due Due to the to the fact fact that that the the polyp polyp was was fragmented fragmented duringduring extraction,extraction, aa preciseprecise marginmargin statusstatus oror thethe depthdepth ofof invasion invasion couldcould not not be be properly properly determined.determined. HistopathologicalHistopathological imagesimages areare presented presented in in Figure Figure1 .1. FigureFigure 1.1. HistopathologicalHistopathological images images of of the the excised excised polyp polyp (A) ( Ain) 10×