Alveolar Rhabdomyosarcoma With Bone Marrow Metastases and Disseminated Intravascular Coagulation Mimicking Acute Lymphoblastic Leukemia: A Case Report

Rhabdomyosarcoma (RMS) is the most common type of soft tissue sarcoma in children and adolescents, with some patients exhibiting bone marrow involvement. Leukemic presentations of RMS have been documented in the literature. However, distinguishing RMS with bone marrow metastasis from acute leukemia can be challenging due to their overlapping morphological features, particularly in the absence of a characteristic primary mass. In this report, we present a case of alveolar rhabdomyosarcoma (ARMS) that was initially misdiagnosed as acute lymphoblastic leukemia (ALL). After reviewing similar case reports, we propose that the presence of scattered cytoplasmic vacuoles in the blast-like cells of the bone marrow, significant differences in the percentage of blast-like cells between the bone marrow and peripheral blood, and the presence of tumor masses in locations typically associated with RMS may serve as indicators for differentiating RMS that mimics acute leukemia.