Terminally differentiated rhabdomyoblasts are common after or during therapy for rhabdomyosarcoma (RMS). Case reports have suggested that their presence after therapy does not indicate a poor prognosis, but significance and relationship to outcome has not been systematically studied. Management of patients with this finding can cause confusion. Slides and pathology reports from 44 patients with bladder/prostate RMS treated on Fourth Intergroup Rhabdomyosarcoma Study were examined by a pathologist experienced in RMS, and findings compared with institutional reports. Details regarding patient characteristics, outcome, and management were reviewed. Outcome of patients with various pathologic findings was assessed. One of 10 patients with only mature rhabdomyoblasts at their last procedure recurred, versus 4 of 17 patients with viable tumor and 2 of 17 patients with no viable tumor and no rhabdomyoblasts. Sixteen of 42 cases reviewed had results differing from our review. Mature rhabdomyoblasts are a discrete entity which may not be predictive of recurrence, but should be evaluated by a pathologist experienced with this entity. The presence of mature rhabdomyoblasts at the end of therapy for bladder/prostate RMS does not justify radical surgery. Sequential biopsies are subject to sampling error and should only be performed in the context of protocol-directed therapy to avoid unnecessary radical surgeries.

译文

在横纹肌肉瘤 (RMS) 治疗后或治疗期间,晚期分化的横纹肌母细胞很常见。病例报告表明,治疗后它们的存在并不表明预后不良,但尚未系统地研究其意义和与结果的关系。对有此发现的患者进行管理可能会引起混乱。由RMS经验丰富的病理学家检查了在第四组间横纹肌肉瘤研究中接受治疗的44例膀胱/前列腺RMS患者的载玻片和病理报告,并将发现与机构报告进行了比较。回顾了有关患者特征,结果和管理的详细信息。评估了具有各种病理发现的患者的结局。最后一次手术中只有成熟横纹肌母细胞的10例患者中有1例复发,而17例有存活肿瘤的患者中有4例复发,而17例没有存活肿瘤且没有横纹肌母细胞的患者中有2例复发。在审查的42例病例中,有16例的结果与我们的审查不同。成熟的横纹肌母细胞是一个离散的实体,可能无法预测复发,但应由具有该实体经验的病理学家进行评估。膀胱/前列腺RMS治疗结束时存在成熟的横纹肌母细胞并不能证明根治性手术是合理的。顺序活检可能会出现采样误差,并且只能在方案指导的治疗中进行,以避免不必要的根治性手术。

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