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Rhabdomyosarcoma of the adult nasopharynx: a case report

Rhabdomyosarcoma is a rare and highly malignant neoplasm of the adult head and neck with a significant incidence of metastases. The outcome for adults with this disease is poorly documented. 
Despite its ominously poor prognosis, combined polychemotherapy, radiotherapy and surgery, whenever feasible, has markedly improved survival rates in some patients. We report the case of a 67-year-old man who presented with a three-week history of a rapidly growing mass on the right upper neck with no symptoms of nasal obstruction, pain in the ears, tinnitus, or headache. Magnetic resonance image (MRI) study of the head and neck revealed a mass in the right and posterior walls of the nasopharynx with extension to the right parapharyngeal space, sphenoid and ethmoid sinuses and enlarged bilateral cervical lymph nodes extending from the submandibular to the supraclaricular regions. Nasopharyngeal biopsy showed poorly differentiated small, blue round cells. A diagnosis of rhabdomyosarcoma was confirmed by positive staining for myo D1, myogenin, desmin and CD56. Combination chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) regimen and radiotherapy was completed within 5 months. Follow up MRI of the head and neck, bone scan and chest X-ray 18 months later revealed neither local recurrence nor distant metastasis.