Cervical rhabdomyosarcoma and EXIT procedure; Case report

A 37 year-old primipara women was referred for management of a large solid tumor found in the neck of her fetus, showing the trachea to be compressed by the mass, and intubation through the ex utero intrapartum treatment (EXIT) was planned. After the mother was anesthetized using a Fentanyl with Isofluorane, the head and left arm of the baby were delivered through a standard lower segment cesarean section, and the baby was intubated with a 3.0 mm tracheal tube before clamping and dividing the umbilical cord, then transferred to a resuscitation table. Time from partial delivery to transfer was 9 min, and the baby weighed 3300 g and quickly achieved acceptable oxygen saturations. A tracheostomy and biopsy of the mass were performed on day 1, and Rhabdomyosarcoma was diagnosed. Multiagent chemotherapy was commenced without any reduction in size (82 × 80 × 70 mm), and radical resection was performed 8 weeks after EXIT. Preoperatively, arterial feeders to the mass arising mainly from the right external carotid artery, were selectively embolized, and surgical excision was performed. After additional chemotherapy and radiotherapy, the child is doing well without recurrence after 3 years of follow-up.