Post-traumatic embryonal rhabdomyosarcoma of the scalp: report of two cases and review of the literature

Embryonal rhabdomyosarcoma (ERMS) development after trauma is a rare occurrence. We first report two cases of head ERMS that developed in the scar of head trauma. The first is that of a 12-year-old boy who was incorrectly considered as hematoma calcification at the first stage because of his shorter head traumatic history (56 days) and the relatively stable feature of mass. Preliminary CT scan and MRI results did not fulfill the diagnosis of malignant tumor. But further pathological examination in the resected tissue demonstrated the feature of lesion and referred to ERMS, leading to the second radical excision of the tumor and further interstitial iodine 125 intervene in the region and adjuvant chemotherapy, with a good prognosis at last. The second case concerns a 10-year-old girl who was same with a head injury history (about 2 months) before presenting a mass in her forehead. However, the volume of mass significantly increased in the few months followed by severe headache and instable walking. MRI and PET-CT both showed local malignant lesion with systemic metastasis. Pathology further confirmed the diagnosis of ERMS. The girl died soon after abandoning treatment. The presented cases suggest that traumatic cerebral lesions may also be a predisposing factor for the development of ERMS and reminder us not to forget the possibility of tumor formation after head injury, especially for these posttraumatic adolescents. As stated by other authors, an association between head trauma and tumor risk cannot be ruled out and should be studied further.