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rhabdomyosarcoma diagnosis

1: Head

Rhabdomyosarcoma of the head and neck is mostly embryonal in children, and botryform sarcoma in the ears, nose and sinuses. All patients presented with mass, with symptoms including exophthalmia, voice change, dysphagia, respiratory obstruction, cough, and discharge from the external ear canal. If the nerve is invaded, acid reflux pain occurs; The swelling and invasive growth of the tumor may aggravate the symptoms and cause brain symptoms. If metastasis occurs, the corresponding symptoms occur.

2. Eye Sockets

Rhabdomyosarcoma can come from the eye muscle or lacrimal gland and is most common in boys aged 7 to 8 years, causing unilateral exophthalmia. The disease progressed rapidly, 1/3 of the children had ptosis, 10% of the children had headache, and X-ray showed bone destruction. Children with unilateral exophthalmia should undergo neurological examination, including carotid X-ray and brain scan. Differential diagnosis should include leukemia and neuroblastoma. Leukemia can be distinguished easily by peripheral blood image and bone marrow smear. When neuroblastoma invades the orbit, the lesions in other parts of the body are more obvious and can be distinguished.

3. Ears

Tumors can occur in the external ear canal, middle ear, mastoid process, or paranasal sinuses. They usually involve only one ear, the opposite side is normal, and unilateral hearing loss often goes unnoticed. It is often treated with succulent fleshy mass in the external ear canal and bloody discharge in the ear, which is easy to be mistaken for inflammatory polyps, so it should be considered especially when children have ear inflammation that is ineffective for antibiotic treatment. Less common is the rapid growth of the posterolateral ear mass, which may be reported as an insignificant bulge at first visit, soft in quality, and may increase to an alarming extent at second visit, because it is painless, the diagnosis is often late. Occasionally facial nerve palsy is the main complaint. Vertigo is a fairly advanced symptom, with the tumor spreading from the middle ear to the mastoid and invading the posterior cranial fossa through the inner plate.

4. Mouth and neck

Rhabdomyosarcoma is a common malignant tumor in childhood, accounting for 50% of all soft tissue sarcomas in children, 45% of which occur in the head and neck, and 25% to 35% of the patients with head and neck rhabdomyosarcoma originally occur in the orbit. Rhabdomyosarcoma can be divided into embryonal, acinar and pleomorphic, and 80% of the orbital rhabdomyosarcoma is embryonal. Embryonal rhabdomyosarcoma includes spindle cell, graphiform, and anaplastic rhabdomyosarcoma, and is easily confused with non-Hodgkin's lymphoma and fibrosarcoma. Embryonal rhabdomyosarcoma originates from the floor of the mouth, tongue, uvula, soft palate, nasopharynx, larynx, lip, nose, gingiva, temporal, buccal, mandibular muscles, parotid glands and neck muscles. The superficial manifestations are simple painless masses, which can be misdiagnosed as benign tumors in the early stage. Laryngeal tumors in young children can cause hoarseness and acute respiratory obstruction. There are two types: high risk and low risk. Low-risk patients can continue to be observed, radiotherapy and chemotherapy if necessary; High-risk patients should be given systematic chemotherapy and radiotherapy after surgery, regular review to prolong survival.

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