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Abstract: The child in this case was brought to the hospital by his family after he developed a facial mass that affected his facial appearance with asymmetry on both sides. After the diagnosis of embryonal rhabdomyosarcoma was made on examination results, the child was admitted to our hospital for inpatient treatment. After excision of the facial mass, the child’s symptoms have improved and there is no sign of recurrence.
Basic information】Female, 7 years old
Type of disease】Muscle tumor (embryonal rhabdomyosarcoma)
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】April 2021
Treatment plan】Surgical treatment (excision of facial masses)
Treatment period】2 weeks of inpatient treatment and 2 months of outpatient follow-up
Results】The child is recovering well and there is no sign of recurrence.
I. Initial consultation
After the initial examination, a quail egg-sized mass could be palpated in the right side of the bite muscle area of the child’s face, and the child was given an imaging test and a puncture needle to take some of the lesion tissue for pathological examination. Although the imaging report showed that the lesion was considered benign, the report of the aspiration cytology suggested tumor cells with a low malignant tendency, and after communication with the child’s family, the child was admitted to our hospital for treatment.
II. Treatment process
The examination showed that the child had facial asymmetry, including a significant enlargement of the right side of the face and a palpable mass of about 1.5 cm × 2.0 cm on the anterior border of the right occlusal muscle. The imaging examination showed a well-defined mass, and since the mass did not show signs of invasion of the surrounding tissues, the result of considering it as a benign lesion was not absolutely wrong. However, since the puncture findings suggested a malignant tumor, we still needed to pay sufficient attention to this child. After communication with the child’s family, we decided to perform surgery on the fourth day of admission. After making an incision in the child’s mouth to separate the surrounding tissues, it was found that the tumor had adhesions with the surrounding occlusal muscles, and then the tumor was excised from the normal tissues at the edge of the tumor and the border tissues were taken for examination. The postoperative pathological results showed that the child had embryonal rhabdomyosarcoma, while the cut edge was not involved.
III. Treatment results
After 2 weeks of surgery and symptomatic treatment, the child is recovering well. Although the child’s face was still swollen at the time of discharge, the condition was relatively improved compared with that at the end of surgery, and the incision did not bleed or crack. At the first month postoperative review, the child’s face had returned to normal, and at the second month postoperative review, the child’s face was basically the same on both sides.
IV. Notes
I am very pleased to see the gradual reduction of the child’s symptoms, but I still need to remind his family to pay attention to some matters after the child is discharged from the hospital.
1, daily pay more attention to oral hygiene, including rinsing after meals, brushing teeth, etc., can use mouthwash rinse, while drinking more water to keep the mouth moist.
2.Because the surgery of the child requires an intra-oral incision, the child needs to eat liquid and softer food, such as rice soup, etc., after the surgery, and at the same time, he should try to eat a light diet within 1 month of appearance.
V. Personal insight
Embryonal rhabdomyosarcoma is a relatively common highly malignant clinical tumor that occurs mostly in children under 15 years of age, but can also be seen in adults. Usually, embryonal rhabdomyosarcoma can occur in any part of the body, mostly in the head, neck, mouth and other parts of the body, but rarely in the extremities. In the case of embryonal rhabdomyosarcoma in infants and children, it is not easy to attract attention or even misdiagnosis because of its complicated clinical manifestations and insidious onset, as well as the deficiencies in expression of the child and the insufficient knowledge of the family about the disease. Fortunately, in this case, the child was detected early and the site of occurrence was ideal, not invading the jaw bone, so the treatment was more complete after surgical excision.