Bone metastases as the presenting manifestation of rhabdomyosarcoma in childhood

Lorraine G. Shapeero, Dominique Couanet, Daniel Vanel, Lauren V. Ackerman, Marie Josée Terrier-Lacombe, Francoise Flamant, Geneviève Contesso, Jean Lumbroso

Research output: Contribution to journalArticlepeer-review


Rarely, rhabdomyosarcoma can present with bone pain and bone lesions on radiographs without evidence of a primary tumor. Of 428 children with biopsyproven rhabdomyosarcoma, four presented with radiographic evidence of bone metastases, but no primary tumor was found on subsequent evaluation. On radiographs, these metastases, located most commonly in the metaphyses of the extremities and in the spine, displayed a destructive or diffusely permeative pattern without sclerotic margins and mimicked the more common neuroblastoma. One patient also had diaphyseal cortical lytic metastases of the tibia. Radiographs defined metastases of the extremities better than the correlative bone scans. In the spine, on T2-weighted magnetic resonance (MR) images, metastases displayed high signal intensity which contrasted with the low-signal-intensity marrow in these pediatric patients. On histopathologic examination, metastatic rhabdomyosarcoma was composed of small cells of variable size, shape, and growth pattern similar to other round cell tumors. A positive desmin immunohistochemical test helped to establish the diagnosis. The radiologist, pathologist, and clinician should be aware of this unusual presentation of rhabdomyosarcoma so that suitable immunohistochemical tests are performed and appropriate chemotherapy given.

Original languageEnglish
Pages (from-to)433-438
Number of pages6
JournalSkeletal Radiology
Issue number6
Publication statusPublished - Aug 1993


  • Bone neoplasms, secondary
  • Bones, radionuclide studies
  • Metastases, magnetic resonance imaging
  • Metastases, radionuclide imaging
  • Neoplasms, metastases
  • Neoplasms, pediatric

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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