Case Report: When obstructive sleep apnea is not benign—nasopharyngeal rhabdomyosarcoma in a 3-year-old
4 affiliations
- 1Department of Pediatrics, Ministry of National Guard Health Affairs, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- 2King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- 3King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- 4Department of Pathology, Ministry of National Guard Health Affairs, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Abstract
Obstructive sleep apnea (OSA) is common in children and is most frequently associated with adenotonsillar hypertrophy. However, similar symptoms may occasionally reflect more serious upper airway pathology. We report a previously healthy 3-year-old boy who presented with snoring, mouth breathing, witnessed apneas, and persistent nasal obstruction in the setting of an acute viral upper respiratory illness. Initial flexible nasopharyngeal endoscopy was limited by copious secretions and poor cooperation, with no obvious mass identified. The subsequent development of epistaxis prompted repeat endoscopic evaluation, which revealed a left-sided nasopharyngeal mass. Imaging demonstrated an aggressive parameningeal lesion with skull base erosion and extension into the cavernous sinus. Histopathological examination, supported by positive immunohistochemical staining for desmin, myogenin, and MyoD1, confirmed embryonal rhabdomyosarcoma. The patient received VAC-based chemotherapy and proton radiotherapy, with subsequent tumor regression and stable findings on long-term imaging follow-up; he remained clinically well approximately four years after completion of therapy. This case highlights the potential for diagnostic anchoring when common symptoms of pediatric OSA coexist with apparently benign conditions such as adenotonsillar hypertrophy or an acute respiratory infection. Incomplete nasopharyngeal visualization should not be considered reassuring when symptoms persist or evolve. The emergence of red-flag features, particularly epistaxis, progressive nasal obstruction, or failure to improve as expected, should prompt timely reassessment and consideration of cross-sectional imaging to exclude an underlying structural lesion.
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BibTeX
@article{abusido2026case,
title = {{Case Report: When obstructive sleep apnea is not benign—nasopharyngeal rhabdomyosarcoma in a 3-year-old}},
author = {Tamer Abusido and Tamer Abusido and Tamer Abusido and Mohammed Alghaihab and Mohammed Alghaihab and Mohammed Alghaihab and Atheer Alyami and Abdulmajeed Alfadhel and Abdulmajeed Alfadhel and Abdulmajeed Alfadhel and Rawan Jarwann and Rawan Jarwann and Rawan Jarwann and Lamia Aldhbiban and Lamia Aldhbiban and Lamia Aldhbiban and Mohammed Alharbi and Mohammed Alharbi and Mohammed Alharbi and Alanood Almuhesseny},
journal = {Frontiers in Pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1971652},
url = {https://doi.org/10.3389/fped.2026.1971652},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: When obstructive sleep apnea is not benign—nasopharyngeal rhabdomyosarcoma in a 3-year-old
AU - Tamer Abusido
AU - Tamer Abusido
AU - Tamer Abusido
AU - Mohammed Alghaihab
AU - Mohammed Alghaihab
AU - Mohammed Alghaihab
AU - Atheer Alyami
AU - Abdulmajeed Alfadhel
AU - Abdulmajeed Alfadhel
AU - Abdulmajeed Alfadhel
AU - Rawan Jarwann
AU - Rawan Jarwann
AU - Rawan Jarwann
AU - Lamia Aldhbiban
AU - Lamia Aldhbiban
AU - Lamia Aldhbiban
AU - Mohammed Alharbi
AU - Mohammed Alharbi
AU - Mohammed Alharbi
AU - Alanood Almuhesseny
PY - 2026
DA - 2026/10/26
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1971652
UR - https://doi.org/10.3389/fped.2026.1971652
AB - Obstructive sleep apnea (OSA) is common in children and is most frequently associated with adenotonsillar hypertrophy. However, similar symptoms may occasionally reflect more serious upper airway pathology. We report a previously healthy 3-year-old boy who presented with snoring, mouth breathing, witnessed apneas, and persistent nasal obstruction in the setting of an acute viral upper respiratory illness. Initial flexible nasopharyngeal endoscopy was limited by copious secretions and poor cooperation, with no obvious mass identified. The subsequent development of epistaxis prompted repeat endoscopic evaluation, which revealed a left-sided nasopharyngeal mass. Imaging demonstrated an aggressive parameningeal lesion with skull base erosion and extension into the cavernous sinus. Histopathological examination, supported by positive immunohistochemical staining for desmin, myogenin, and MyoD1, confirmed embryonal rhabdomyosarcoma. The patient received VAC-based chemotherapy and proton radiotherapy, with subsequent tumor regression and stable findings on long-term imaging follow-up; he remained clinically well approximately four years after completion of therapy. This case highlights the potential for diagnostic anchoring when common symptoms of pediatric OSA coexist with apparently benign conditions such as adenotonsillar hypertrophy or an acute respiratory infection. Incomplete nasopharyngeal visualization should not be considered reassuring when symptoms persist or evolve. The emergence of red-flag features, particularly epistaxis, progressive nasal obstruction, or failure to improve as expected, should prompt timely reassessment and consideration of cross-sectional imaging to exclude an underlying structural lesion.
SN - 2296-2360
ER -