title: Cranial metastatic alveolar rhabdomyosarcoma mimicking hematological malignancy in an adolescent boy.
abstract: BACKGROUND
  Widespread alveolar rhabdomyosarcoma (ARMS) with bone marrow involvement and with an unknown primary tumor, especially presenting with acute tumor lysis syndrome can be easily misdiagnosed as a hematological malignancy. Furthermore, brain metastasis of ARMS is rare seen in children.
  
  
  METHODS
  Herein, we report a 14-year-old boy presenting with acute tumor lysis syndrome due to bone marrow invasion of ARMS, who was diagnosed after abdominal paraaortic lymph node biopsy. Despite radiological and nuclear medicine imaging, the primary tumor site could not be found. He was treated with vincristine, topotecan, and cyclophosphamide for 42 weeks. Six months after the completion of treatment, he suffered from severe headache, blurred vision, right hemiplegia, and severe bone pain. Cranial magnetic resonance imaging showed multiple hemorrhagic infarctions. Brain biopsy showed brain metastasis with PAX3-FKHR fusion transcript.
  
  
  CONCLUSIONS
  The clinicians must be vigilant about solely brain metastasis in ARMS without additional metastasis.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey, turkanp@erciyes.edu.tr.
authors.forename: Turkan
authors.initials: T
authors.lastname: Patiroglu
authors.forename: Bilgen
authors.initials: B
authors.lastname: Isik
authors.forename: Ekrem
authors.initials: E
authors.lastname: Unal
authors.forename: Ozlem
authors.initials: O
authors.lastname: Canoz
authors.forename: Kemal
authors.initials: K
authors.lastname: Deniz
authors.forename: Kemal
authors.initials: K
authors.lastname: Kosemehmetoglu
authors.forename: Musa
authors.initials: M
authors.lastname: Karakukcu
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Ozdemir
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary*; D019337:Hematologic Neoplasms / Q000235:genetics / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D051761:Paired Box Transcription Factors / Q000235:genetics; D018232:Rhabdomyosarcoma, Alveolar / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents; D015514:Oncogene Proteins, Fusion; C471563:PAX3-FOXO1A fusion protein, human; D051761:Paired Box Transcription Factors