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Embryonal Rhabdomyosarcoma of the Bile Ducts Causing Obstructive Jaundice in a Child: A Case Report
Juan Miguel L Murillo1, Germana Emerita V Gregorio1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Insights
Embryonal Rhabdomyosarcoma, a rare bile duct tumor, caused obstructive jaundice in a child. This case highlights the importance of considering rare tumors in pediatric obstructive jaundice diagnoses.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Pathology
Background:
- Obstructive jaundice in children typically results from gallstones, parasites, or choledochal cysts.
- Tumors obstructing the bile ducts are a rare but serious cause of jaundice in pediatric patients.
Observation:
- A 10-year-old boy presented with progressive jaundice and tea-colored urine, initially suspected to be biliary ascariasis.
- Imaging revealed an exophytic mass at the ampulla of Vater, confirmed as Embryonal Rhabdomyosarcoma via biopsy.
Findings:
- Embryonal Rhabdomyosarcoma of the bile ducts is an extremely rare diagnosis in children.
- The tumor showed aggressive growth despite chemotherapy, leading to complications and the patient's demise.
Implications:
- This case underscores the necessity of including rare tumors in the differential diagnosis for pediatric obstructive jaundice.
- Early recognition and appropriate management strategies for rare pediatric biliary tumors are critical, though challenging.
Abstract:
Jaundice in older children can occur when any obstruction is found within the bile ducts, either from bile stones, parasites, choledochal cysts and rarely, secondary to tumors. We present a previously well, 10-year-old Filipino boy with three-week history of progressive jaundice and tea-colored urine, and was initially assessed to have biliary ascariasis. Ultrasound showed a heterogeneous focus spanning the gallbladder neck and confirmed on endoscopic retrograde cholangiopancreatography as an exophytic mass at the ampulla of Vater. Tumor biopsy and immunohistochemical staining confirmed the diagnosis of Embryonal Rhabdomyosarcoma of the Bile Ducts. Chemotherapy was initiated to reduce the size of the tumor before any surgical intervention could be attempted. Despite chemotherapy, the tumor progressively grew. He acquired a respiratory infection which led to sepsis and his eventual demise. The disease should be considered in the differential diagnosis of a child with obstructive jaundice after exclusion of other more common causes.
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