Case submitted by Kay Ogenda, M.D., radiologist, to

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A 45-year-old female presents with an increasing growth on the right neck. A CT scan revealed an extremely large heterogeneous mass in the right supraclavicular region. Findings are consistent with a high grade sarcoma of the sternocleidomastoid muscle. Specifically, this lesion is consistent with rhabdomyosarcoma of muscular origin.

 Soft-tissue sarcomas are malignant lesions that originate from soft tissues. Rhabdomyosarcomas arise from muscle cells and are most commonly found in children. They account for up to 10 percent of childhood malignancies and 20 percent of all pediatric soft tissue sarcomas. 

There is a slight male predominance of incidence of sarcomas. Clinical presentation will vary on the location of a tumor. In this case, rhabdomyosarcomas are rapidly growing masses with mass effect on neurovascular structures, as well as with extensive infiltration often seen of adjacent structures, including bones and adjacent organs. Rhabdomyosarcomas can occur anywhere, but they particularly develop where skeletal muscle is located. The most common locations include the head, neck, and pelvis.

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What is your diagnosis for a patient who presents with increasing size of neck and shoulder region?

Image IQ Quiz (Video): Patient Presents with Enlarging Neck and Shoulder Region