A Nose Bleed Reveals Rhabdomyosarcoma's Seed

Embryonal rhabdomyosarcoma is the malignant mesenchymal proliferation of undifferentiated skeletal muscle. It is the most common soft tissue tumour found in children. Head and neck location accounts for 40% of the cases with the most common variants being of embryonal Nasopharyngeal RMS is a type of parameningeal RMS (arising from tissues adjacent to the meninges) having propensity for CNS and known for having a poorer prognosis, early recurrence, rapid growth and invasion to adjacent structures. Other types of RMS include orbital and non-orbital/non-parameningeal. Here, we encountered a rare case of a 5 year old boy presenting with complaints of epistaxis. On anterior rhinoscopy of the nose, no apparent mass could be visualised. However, on oral examination, a right sided oropharyngeal bulge was noted. Clinical evidence was corroborated radiologically with MRI neck findings which suggested a hyperintense lesion with heterogeneous enhancement in the region of right side of nasopharynx extending laterally into parapharyngeal region and carotid space, encasing the right internal carotid artery with narrowing of nasopharyngeal airway. Hence, biopsy was taken from the nasopharynx and a diagnosis of embryonal rhabdomyosarcoma - botryoid type was made which was confirmed with IHC markers.