{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:32Z","timestamp":1756339412373,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,3,10]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>Rhabdomyosarcoma is a rare mesenchymal malignancy with four different morphological subtypes: alveolar, embryonal, pleomorphic and spindle cell\/sclerosing. It is the most common soft tissue sarcoma of children and adolescents but occurs less commonly in adults. We describe a male patient in his 20s with sclerosing rhabdomyosarcoma of the left cheek who developed an isolated free flap donor site metastasis in the first instance but subsequently progressed with bilateral pulmonary metastases. Multidisciplinary team involvement in a sarcoma specialist centre is essential and collaboration between the pathologist, radiologist, head and neck surgeon, orthopaedic surgeon, radiation oncologist and medical oncologist were integral in providing optimal management in this patient. Furthermore, this case report highlights this phenomenon of implantation metastasis in a patient with rhabdomyosarcoma, and emphasises the importance of surgical barriers between the resection and reconstruction teams in an oncological case.<\/jats:p>","DOI":"10.1136\/bcr-2021-248390","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T12:51:20Z","timestamp":1649335880000},"page":"e248390","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Left cheek sclerosing rhabdomyosarcoma and development of isolated free flap donor site metastasis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5918-4439","authenticated-orcid":false,"given":"Deborah","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Bhadri","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia"},{"name":"The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Luk","sequence":"additional","affiliation":[{"name":"Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney","family":"Ch\u2019ng","sequence":"additional","affiliation":[{"name":"The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Franks","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Hong","sequence":"additional","affiliation":[{"name":"The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Radiation Oncology, Chris O\u2019Brien Lifehouse, Camperdown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"key":"2025082702211234000_15.4.e248390.1","first-page":"1604","article-title":"NCCN guidelines insights: soft tissue sarcoma, version 1.2021: Featured updates to the NCCN guidelines","volume":"18","author":"von Mehren","year":"2020","journal-title":"JCCN"},{"key":"2025082702211234000_15.4.e248390.2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1200\/JCO.2017.74.7402","article-title":"Rhabdomyosarcoma, Ewing sarcoma, and other round cell sarcomas","volume":"36","author":"Pappo","year":"2018","journal-title":"J Clin Oncol"},{"key":"2025082702211234000_15.4.e248390.3","unstructured":"Amin MB , Edge SB , Greene FL . Ajcc cancer staging manual. 8th ed. New York: Springer, 2017."},{"key":"2025082702211234000_15.4.e248390.4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00238-011-0628-4","article-title":"Cutaneous melanoma metastases arising in the donor and recipient sites of a skin graft: case report and review of the literature","volume":"36","author":"Wallace","year":"2013","journal-title":"Eur J Plast Surg"},{"key":"2025082702211234000_15.4.e248390.5","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/DSS.0000000000001283","article-title":"Cutaneous metastases of melanoma affecting exclusively skin graft donor and receiving sites: a novel clinical presentation","volume":"44","author":"Giudice","year":"2018","journal-title":"Dermatol Surg"},{"key":"2025082702211234000_15.4.e248390.6","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s00238-012-0786-z","article-title":"The development of squamous cell carcinomas in split-thickness skin graft donor sites","volume":"36","author":"Morritt","year":"2013","journal-title":"Eur J Plast Surg"},{"key":"2025082702211234000_15.4.e248390.7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/230949900301100118","article-title":"Implantation metastasis in a 13-year-old girl: a case report","volume":"11","author":"Singh","year":"2003","journal-title":"J Orthop Surg"},{"key":"2025082702211234000_15.4.e248390.8","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s002640050105","article-title":"A pelvic osteosarcoma with metastasis to the donor site of the bone graft","volume":"20","author":"Yip","year":"1997","journal-title":"Int Orthop"},{"key":"2025082702211234000_15.4.e248390.9","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00590-012-1055-3","article-title":"Iatrogenic implantation of giant cell tumor at bone graft donor site and clinical recommendations to prevent \"a rare avoidable complication\"","volume":"23","author":"Gulia","year":"2013","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2025082702211234000_15.4.e248390.10","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/BLO.0b013e31813ffbd8","article-title":"Iatrogenic seeding of a giant cell tumor of the patella to the proximal tibia","volume":"465","author":"Ofluoglu","year":"2007","journal-title":"Clin Orthop Relat Res"},{"key":"2025082702211234000_15.4.e248390.11","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1002\/ccr3.1395","article-title":"Iatrogenic seeding of osteosarcoma in a tracheotomy tract - a case report","volume":"6","author":"Duek","year":"2018","journal-title":"Clin Case Rep"},{"key":"2025082702211234000_15.4.e248390.12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/2278-330X.155704","article-title":"Iatrogenic implantation of soft tissue sarcoma at skin graft donor site: delayed manifestation of an avoidable complication","volume":"4","author":"Pai","year":"2015","journal-title":"South Asian J Cancer"},{"key":"2025082702211234000_15.4.e248390.13","doi-asserted-by":"crossref","first-page":"E440","DOI":"10.1002\/lary.28697","article-title":"Squamous cell carcinoma metastasis to the supraclavicular artery island flap donor site","volume":"131","author":"West","year":"2021","journal-title":"Laryngoscope"},{"key":"2025082702211234000_15.4.e248390.14","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1177\/0003489420917418","article-title":"Implantation of squamous cell carcinoma in a free flap donor site","volume":"129","author":"Pichardo","year":"2020","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2025082702211234000_15.4.e248390.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.05.010"},{"key":"2025082702211234000_15.4.e248390.16","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1002\/hed.25652","article-title":"Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: review of the literature","volume":"41","author":"Rowell","year":"2019","journal-title":"Head Neck"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-248390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:21:17Z","timestamp":1756286477000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-248390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,7]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/bcr-2021-248390"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-248390","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,4]]}}}