title: Clinicopathologic analysis of spindle cell/sclerosing rhabdomyosarcoma.
abstract: BACKGROUND
  Clinical characteristics and optimal treatment strategies for spindle cell/sclerosing rhabdomyosarcoma (ssRMS) have not been well established because of its rarity.
  
  
  METHODS
  Retrospective re-evaluation of sarcoma specimens (1997-2014) identified 16 ssRMSs (median age 20 years, range 7-39 years). Clinicopathological features, clinical course, and outcome were analyzed.
  
  
  RESULTS
  Primary disease sites were the head and neck (10 cases) and other regions (6 cases). Nine cases were at Intergroup Rhabdomyosarcoma Study preoperative stage 3. The primary tumors were >5 cm in 13 cases. Two patients had lymph node metastases, but none had distant metastases at presentation. At follow-up (median period 39 months, range 4.6-201), seven patients were alive without disease. Among nine patients treated with the vincristine, actinomycin, and cyclophosphamide (VAC) regimen, five responded well, with four surviving free of disease. Among ten patients with recurrent or progressive disease, three experienced local recurrence, four had distant metastases, and three had both. None exhibited bone marrow invasion. Eight of the ten patients died in median time from relapse to death of 18 months (range 11-56).
  
  
  CONCLUSIONS
  Although most ssRMSs present as a bulky tumor, nodal or distant metastases are rare at presentation. ssRMSs initially show good response to VAC, but >50% of tumors recur or progress; these data suggest a worse prognosis of ssRMS compared to the pediatric embryonal variant. As relapse typically occurs as local or distant solitary lesion without bone marrow invasion, localized treatment combined with chemotherapy would contribute to improve the prognosis of recurrent ssRMS.
authors.affiliation: Division of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yasui
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Kan
authors.initials: K
authors.lastname: Yonemori
authors.forename: Ako
authors.initials: A
authors.lastname: Hosono
authors.forename: Akira
authors.initials: A
authors.lastname: Kawai
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D017570:MyoD Protein / Q000032:analysis; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000737:chemistry / Q000473:pathology* / Q000628:therapy
chemical_list: D017570:MyoD Protein; C057363:MyoD1 myogenic differentiation protein
keywords: chemotherapy; sclerosing rhabdomyosarcoma; spindle cell rhabdomyosarcoma