Embryonal Rhabdomyosarcoma of The Urinary Bladder Complicated By Vesicocutaneous Fistula with Fatal Clinical Course: A Case Report

Andesty Andesty; Joko  Pitoyo

doi:10.58344/ihj.v5i3.940

Authors

Andesty Andesty Universitas Riau
Joko Pitoyo Universitas Riau

DOI:

https://doi.org/10.58344/ihj.v5i3.940

Keywords:

Embryonal Rhabdomyosarcoma, Bladder Pediatric, Vesicocutaneous Fistula, Ifosfamide-Induced Encephalopathy

Abstract

This report describes a case of embryonal rhabdomyosarcoma of the urinary bladder in a 4-year-and-11-month-old boy with an aggressive clinical course complicated by multiple concurrent complications. A 4-year-and-11-month-old boy presented with a 2-month history of progressive abdominal distension, urinary retention, and abdominal pain. Ultrasonography revealed a solid mass infiltrating the urinary bladder with bilateral hydronephrosis. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis demonstrated a mixed-density pelvic mass with infiltration of the posterior wall of the urinary bladder. Laparotomy biopsy and cystoscopy were performed, revealing multiple papillary lesions on the bladder mucosa. Histopathological examination confirmed embryonal rhabdomyosarcoma of the urinary bladder, and immunohistochemical analysis using antibodies against desmin, vimentin, Ki-67, and myogenin showed positive expression for all markers. The patient subsequently developed a vesicocutaneous fistula as a postoperative complication, followed by ifosfamide-induced encephalopathy after initiation of VAI chemotherapy, resulting in progressive clinical deterioration and death on the 18th day of the final hospitalization.Embryonal rhabdomyosarcoma of the urinary bladder is a rare malignancy that presents significant diagnostic challenges. Clinicians should maintain a high index of suspicion for this entity and perform immunohistochemical examinations as a critical step in establishing an accurate diagnosis. Multiple concurrent complications, such as vesicocutaneous fistula and ifosfamide-induced encephalopathy, may further worsen clinical outcomes, underscoring the importance of early diagnosis, nutritional optimization, and prompt multidisciplinary management.

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