ve of alveolar type of rhabdomyosarcoma. Thus final diagnosis of Alveolar type of Rhabdomyosarcoma (made depending upon the HPE report) with lymph node metastasis was made. Paediatric consultation was repeated and as per advice chemoreduction with vincristine, Adriamycin and Ifosamide tried. The mass did not reduce in size so planned for debulking surgery and second cycle chemotherapy but patient got discharged against medical advice. DISCUSSION Although the tumor is believed to arise from primitive muscle cells, tumors can occur anywhere in the body except bone. The most common sites are the head and neck (28%), extremities (24%), and genitourinary (GU) tract (18%). Other notable sites include the trunk (11%), orbit (7%), and retroperitoneum (6%). Approximately 87% of patients are younger than 15 years, and 13% of patients are aged 1521 years. Our patient age is also quite same as
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in a case series mentioned by Kaliaperumal et al.4 where the age of the patients ranged from 3 to 29 years. The finding of proptosis in children as the most common presenting sign in our patient underlines the importance of orbital rhabdomyosarcoma in the differential diagnosis of such a presentation. Jones et al., have reported that 100% of the cases in their study had proptosis5. However, Schinter et al., have documented 71% of cases with proptosis6. Boparai and Dash, in their case series had eleven out of 14 cases presenting with acute onset proptosis with inflammatory signs7. The symptoms in our patient arise as a small lid mass. There are also case reports on rhabdomyosarcoma in which the cases have presented as palpable lid nodules and on occasion felt to be a chalazion, cystic lesions or lid tumor of vascular origin8,9. Awareness about these less common presentations of this fatal malignancy is essential to ensure early detection and initiation of treatment. X-ray is not of much help in the diagnosis but CT scan gives an idea of the total extent of the lesion. CT scan is also of tremendous value in follow up to detect recurrence. Metastases are found predominantly in the lungs, bone marrow, bones, lymph nodes, breasts, and brain. Four histopathological subtypes of rhabdomyosarcoma have been described: embryonal, alveolar, botryoides and pleomorphic10. It is believed that the embryonal, alveolar and botryoides variants are of mesenchymal origin and that the pleomorphic variant is derived from mature skeletal muscle. The pleomorphic type is the most differentiated type and carries the best prognosis followed by the embryonal and botryoides types10. The alveolar type has been shown to carry the worst prognosis. Thus our case was the one with the worst prognosis. Earlier orbital rhabdomyosarcoma was treated by orbital exenteration. In 1979, Abraham et al. demonstrated irradiation alone or in combination with chemotherapy to be more effecti-