Pancreatic Metastasis of Alveolar Rhabdomyosarcoma Presenting as Acute Pancreatitis

A 14-year-old girl, known case of rhabdomyosarcoma (RMS) of head and neck (zygomatic region accompanied by cervical lymphadenopathies) was admitted with severe epigastric unrelenting pain. She was receiving chemotherapy for intermediate-risk RMS with standard VAC (vincristine, dactinomycin, and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide (VAC/VTC) for the last eight months. On admission, she was mildly icteric and afebrile. Ultrasound examination at that time showed minimally dilated intra and extra hepatic and common bile ducts. Head and neck of the pancreas had increased size with anteroposterior diameter of about 26.4 mm and minimal free fluid was observed anterior to the pancreas. She was diagnosed with “acute pancreatitis” due to associated signs and symptoms and increased levels of amylase and lipase to more than three times.