The role of magnetic resonance imaging in cervical embryonal rhabdomyosarcoma: the first reported case in an Indonesian adolescent

Abstract Background The uterine cervix is a rare location for embryonal rhabdomyosarcoma (ERMS), accounting for only 0.2% of malignant uterine tumours in adult females. This case report presents a 16-year-old female with heavy extra-menstrual bleeding, with a more deliberate focus towards the radiological challenge in interpreting cervical ERMS. Case Report A 16-year-old female presented with intermittent lower abdominal pain, nausea, vomiting, difficulty defecating, and severe vaginal bleeding. She had a history of high-grade cervical sarcoma diagnosed four months prior, with histopathology inconclusive between rhabdomyosarcoma and leiomyosarcoma. Physical examination revealed anaemia and a polypoid mass protruding from the cervix. She received blood transfusions to address severe anaemia. Persistent symptoms led to another transfusion and chemotherapy regimen (vincristine, actinomycin D, ifosfamide, paclitaxel, and carboplatin). Follow-up imaging initially showed no masses, but a subsequent MRI revealed a heterogeneous mass extending from the uterus to the cervix and proximal vagina. A total hysterectomy was performed, and histopathology confirmed cervical ERMS. Post-operative MRI showed no residual tumour, and the patient continued with follow-up chemotherapy sessions. Conclusion This case highlights the complexities of diagnosing and managing cervical ERMS in adolescents. MRI was crucial in evaluating tumour extent and guiding treatment.