Rhabdomyosarcoma is the most common mesenchymal malignant tumor in children but primary paravertebral location with spinal cord compression is rare. A 2-year-old girl presented with swelling in upper back of two month duration and progressive weakness of both lower limbs of 1½-month duration. On examination, she had spastic paraparesis and a diffuse swelling at the level of D_4-5, firm to soft in consistency with ill-defined margins and mild tenderness. Magnetic resonance imaging revealed a dumbbell shaped mass at D3-5 level with extension into chest wall and paraspinal area. The mass was isointense to spinal cord on T1WI and hyperintense on T2WI (Fig. 1).

(a)                          (b)                                                    (C) Fig. 1 (a) Sagittal T1WI MRI showing isointense epidural and paraspinal mass at D3-D5 level; (b) Sagittal T2WI MRI showing hyperintense mass; (c) Axial T2WI showed T2 hyperintense dumbell-shaped epidural mass involving adjoining chest wall with severely compressed cord displaced to the left.

D_3-5 laminectomy revealed a fleshy, vascular mass with areas of hemorrhage. Tumor from epidural and paraspinal area was removed completely. Histopathology and immunohistochemistry confirmed the diagnosis of alveolar rhabdomyosarcoma. Tumor cells expressed vimentin and desmin. Patient showed rapid improvement in motor power in immediate post-operative period and was given 12 cycles of chemotherapy (Vincristine, Adriamycin , Cyclophosphamide, Mesna) and 41 Gy of radiotherapy. Positron Emission Tomography scan in the follow up period revealed no recurrence of the tumor and patient is symptom-free for the last three years.

Primary spinal epidural rhabdomyosarcoma is an extremely rare tumor and only few cases have been reported [1-4]. Treatment includes combination of surgery, chemotherapy and radiotherapy. Prognosis depends upon the age of patient, extent of the tumor, tumor histology, and presence of metastasis. When an epidural spinal mass with nonspecific imaging findings is found, rhabdomyo-sarcoma should be included in the differential diagnosis. Follow-up imaging is important to monitor tumor regression during or after completion of chemotherapy and radiotherapy, and to detect tumor recurrence or metastasis.