Recurrent rhabdomyosarcoma after 25 years : A possible association with estrogen and progestogen therapy

We describe a patient with a late recurrence of rhabdomyosarcoma and review the relevant literature. Recurrent rhabdomyosarcoma occurred in a young woman 25 years after initial presentation, with the onset of symptoms 3 months after commencing hormonal replacement therapy with estrogen and progestogen. The primary and recurrent tumors were immunocytochemically identical. The primary tumor was steroid receptor negative but the recurrent tumor was estrogen and progesterone receptor positive. Estrogen priming can stimulate synthesis of progesterone receptors which may modulate mitotic activity, which suggests a functional role for receptor positive cells in modulating cell growth when sex hormone primed, with a possible tumor induction role of sex hormone replacement therapy. The late tumor recurrence may have been induced by estrogen and progestogen treatment.