Supplementary Material for: Wide Excision Choice in Orbital Rhabdomyosarcoma on an 8-year-old Patient in a Low-Resource Setting: A Case Report

Introduction
Rhabdomyosarcoma is the most common neoplasm of skeletal myoblast-like cells in children aged 5 to 8 years. It typically occurs in the head, neck region, genitourinary tract, retroperitoneum, and extremities.
Case presentation
An 8-year-old boy complained of a lump under his left eye that he had felt for the past 4 years. Initially small, it gradually grew larger although there were no accompanying symptoms of redness, pain, itching, or eye movement disorders, and no history of trauma. Visual acuity in the left eye was measured at 6/15, with pinhole correction improving to 6/6, while the right eye was 6/6. Intraocular pressure in both eyes was 15mmHg. Anterior segment examination of the left eye revealed a mass on the lower eyelid with hard consistency, no erythema, no tenderness, with a flat surface, immobility, and all aspects of the conjunctiva, cornea, pupil, and lens appearing normal. A contrast CT scan showed a solid mass measuring 2.1 x 1.9 x 1.9 cm, suggesting a left inferior eyelid mass. The patient underwent surgical excision of the tumor under general anesthesia. Histopathological examination confirmed the diagnosis of embryonal rhabdomyosarcoma. The patient was scheduled for chemotherapy.
Discussion
Orbital rhabdomyosarcoma typically presents with sudden onset and rapid proptosis, without a history of trauma or respiratory tract infections. The embryonal subtype is the most common. The goal of surgery is to obtain tissue either through excisional or incisional biopsy, providing pathological confirmation of the diagnosis and histopathologic typing for appropriate management with chemotherapy or radiation. In low-resource settings, rhabdomyosarcoma pose significant challenges due to limited access to necessary medical tools and interventions. Clinical suspicion and thorough physical examination are crucial for early detection. Treatment must be adapted based on available resources and regular follow-up is vital to monitor treatment outcomes.
Conclusion
Any swelling in children should be carefully examined, and treatment outcomes should be regularly followed up, even in low-resource settings. Orbital rhabdomyosarcoma has a better prognosis with combined therapy including excisional surgery, chemotherapy, and radiation.