Pleomorphic rhabdomyosarcoma of the liver with a hepatic cyst in an adult: Case report and literature review

RATIONALE: Rhabdomyosarcoma (RMS), a malignant tumor with striated muscle differentiation, is the most common type of soft-tissue sarcoma in children and adolescents, but rarely occurs in adults, and especially in human livers. Moreover, this disease has a very poor prognosis. Here we report a case of primary RMS of the liver in a 66-year-old woman. This case is rare with respect to the location and clinical course of the tumor. The tumor had enlarged rapidly, ruptured, and eventually caused the patient's death after a long history of a stable abdominal mass that indicated a hepatic cyst. PATIENT CONCERNS: Before admission, a patient with a 5-year history of an abdominal mass was admitted to another hospital with symptoms of aggravated epigastric pain for the past 10 days. She was diagnosed with a hepatic cyst that had ruptured and hemorrhaged and was infected. This initial diagnosis was based on operative and pathologic findings. DIAGNOSES: Pleomorphic RMS of the liver with a hepatic cyst was diagnosed and confirmed by imaging, surgery, and histopathological evaluation. INTERVENTIONS: Following admission, an emergency laparotomy was performed to treat the intra-abdominal hemorrhaging while further examinations were performed. Post-surgical histopathological evaluation found pleomorphic RMS tissue in the large mass that occupied the right lobe of the liver. No adjuvant chemotherapy was administered. OUTCOMES: The patient died from malnutrition and multiple organ failure 141 days after her initial admission. LESSONS: Rhabdomyosarcomas in the liver are highly malignant tumors; therefore, early diagnosis and timely surgical resection are necessary to improve a patient's prognosis. We recommend that greater attention should be paid to a differential diagnosis of RMS for patients with hepatic masses that have ruptured. Moreover, preoperative imaging studies and percutaneous biopsy would be helpful for making a more specific diagnosis, and adjuvant chemotherapy should be administered for further treatment and for the purposes of future research.