A one month old female infant is brought to you for evaluation of afriable polypoid mass prolapsing through the vaginal introitus. Your presumptive diagnosis is which of the following?

d. Embryonal rhabdomyosarcoma

Vaginal and cervical primary rhabdomyosarcomas often prolapse through the vaginal orifice as a friable polypoid mass and may hemorrhage. Botyroid tumors are really of the embryonal subtype but grow into a hollow space such as the vagina or bladder so they undertake a characteristic “grape-like” appearance. Other patterns of rhabdomyosarcoma include alveolar and pleomorphic morphology. The incidence of rhabdomysarcoma is biphasic with one peak in infancy followed by the second in the adolescent years. The nature of presentation is site dependent. This patient has a classical presentation for a vaginal botyroid rhabdomyosarcoma. The emphasis in evaluation is to perform a thorough pretreatment workup that defines completely local tumor extent and evaluates the regional and distant sites of metastases.