Nasopharyngeal Rhabdomyosarcoma: A Rare Malignancy Incidentally Found in a Middle-Aged Male with a Diagnostic Dilemma

Abstract

Nasopharyngeal rhabdomyosarcoma is a rare tumour of the paediatric age group that emerges from embryonal mesenchymal cells. Presented here is a case of a 54-year-old male of Asian ethnicity with a notable history of weight loss, lack of energy, anal fissure, and haematochezia. After the incidental finding of a lytic lesion following imaging, the patient underwent an extensive work-up to rule out malignancy and increased uptake on nasopharynx was found, which was biopsied to diagnose a poorly differentiated tumour, having desmin and myogenin positivity on immunohistochemistry. Metastatic work-up showed extensive bone marrow invasion apart from multiple lytic bone lesions throughout the body. The patient was started on vincristine, actinomycin D (dactinomycin), and cyclophosphamide (VAC) protocol chemotherapy and was followed-up until two cycles were completed, with no evidence of disease remission.