Primary peritoneal embryonal rhabdomyosarcoma in a 6-year-old girl with rapid post-surgical peritoneal recurrence possibly due to surgical tumor seeding: a case report and review of the literature

BACKGROUND: Primary peritoneal rhabdomyosarcoma is an exceedingly rare soft tissue malignancy in the pediatric population. Little is known about iatrogenic tumor cell peritoneal seeding after primary surgical resection of peritoneal rhabdomyosarcoma, and there is limited guidance on optimal management of such cases. Its aggressive nature, coupled with widespread peritoneal tumor seeding, contributes to the poor outcome of such cases. CASE PRESENTATION: A 6-year-old Tigrayan girl from Northern Ethiopia presented with lower abdominal swelling of 1 month duration. Abdominopelvic ultrasound and computed tomography scan revealed a well-defined pelvic solid mass located in front of the uterus and bladder. Exploratory laparotomy demonstrated an 8-cm mass attached to the lower abdominal wall and anterior pelvic peritoneum with no other mass lesion. Complete resection of the mass was done, and a subsequent histopathologic examination along with immunohistochemistry for desmin and myogenin confirmed the diagnosis of embryonal rhabdomyosarcoma. Five weeks postoperatively, she returned with multiple peritoneal malignant depositions. She was given systemic chemotherapy but died before receiving the second cycle. CONCLUSION: The aggressive nature of primary peritoneal rhabdomyosarcoma and the possible influence of surgical handling on recurrence are both highlighted in this case. To achieve an optimal outcome, early multimodal therapy and preventive surgical techniques are essential.