Abstract
RATIONALE: Alveolar rhabdomyosarcoma (ARMS) is a rare and highly aggressive malignant soft tissue tumor. ARMS is associated with a poor prognosis, especially in adults, occurring in the uterine cervix infrequently. To date, only 6 cases have been reported in the literature. We discuss the challenges in diagnosing and managing cervical ARMS and highlights the need for ongoing research into optimal treatment strategies for this malignancy. PATIENT CONCERNS: A 51-year-old female was diagnosed with advanced-stage ARMS. Positron emission tomography and computed tomography scans indicated a high metabolism mass in the uterus region, along with multiple lymph nodes enlargement in the pelvic, para-aorta and mediastinal regions. Cervical biopsy and segmental curettage revealed a small cell malignant tumor with poor differentiation. Histological and immunohistochemical examination confirmed ARMS. DIAGNOSES: The final diagnosis was cervical ARMS, staged IV according to the Intergroup Rhabdomyosarcoma Studies Group based on the imaging and histology results. INTERVENTIONS: The patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. Postoperatively, the patient received a series of chemotherapy regimens including VAC† (vincristine, epirubicin, cyclophosphamide), EP (etoposide and cisplatin), VIP (etoposide, ifosfamide, cisplatin), gemcitabine and bevacizumab, gemcitabine and docetaxel, pertuzumab and lenvatinib and radiotherapy. CONCLUSION: ARMS has low incidence with unique clinical pathological characteristics. The biological behavior is more aggressive and the prognosis is worse in ARMS. Further research is necessary to refine treatment protocols and improve survival rates for this aggressive tumor.