title: Alveolar rhabdomyosarcoma of the anterior mediastinum with vessel invasion in a 4-month-old boy: a case report.
abstract: BACKGROUND
  Alveolar rhabdomyosarcomas of the mediastinum in children are rarely reported. Multimodality therapy including chemotherapy, surgery and radiotherapy make up the backbone of the treatment of childhood rhabdomyosarcomas. Complete resection whenever achievable is an important prognostic factor. However, complete resection of tumors in the mediastinum often poses a unique challenge to thoracic surgeons due to their close proximity to important neurovascular structures. Complete resection may not always be possible and judicious peri-operative planning and preparation are required to avoid creating unnecessary surgical morbidities resulting in delay of adjuvant therapy.
  
  
  METHODS
  A 4-month-old Chinese baby boy was presented to our hospital with stridor, shortness of breath and episodes of cyanosis. Imaging studies found an anterior mediastinal mass compressing the trachea and other neurovascular structures and he was diagnosed to have alveolar rhabdomyosarcoma. Our patient received upfront chemotherapy and subsequently open resection of the mass was attempted via median sternotomy. Intraoperatively, the mass had invaded into the great vessels, precluding a complete resection. Debulking surgery was performed instead and our patient received timely postoperative chemoradiotherapy.
  
  
  CONCLUSIONS
  We report a rare case of childhood alveolar rhabdomyosarcoma of the mediastinum with vascular invasion treated with chemoradiotherapy and debulking surgery. Complete resection was not possible due to the close proximity to the great vessels. Different surgical approaches to the mediastinum have been reported in adults and children alike. Regardless of the surgical access, the treatment of childhood rhabdomyosarcomas should be individualized, with careful balance between surgical clearance and surgical morbidity.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. wwjdsimon@gmail.com.
authors.forename: Simon C Y
authors.initials: SC
authors.lastname: Chow
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. wonhl1@surgery.cuhk.edu.hk.
authors.forename: Randolph H L
authors.initials: RH
authors.lastname: Wong
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. innesw@surgery.cuhk.edu.hk.
authors.forename: Innes Y P
authors.initials: IY
authors.lastname: Wan
authors.affiliation: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. kfto@cuhk.edu.hk.
authors.forename: Ka Fai
authors.initials: KF
authors.lastname: To
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. swan@surgery.cuhk.edu.hk.
authors.forename: Song
authors.initials: S
authors.lastname: Wan
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. mjunderwood@surgery.cuhk.edu.hk.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Underwood
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories Hong Kong. calvinng@surgery.cuhk.edu.hk.
authors.forename: Calvin S H
authors.initials: CS
authors.lastname: Ng
mesh_terms: D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness; D018232:Rhabdomyosarcoma, Alveolar / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D014057:Tomography, X-Ray Computed