Case Report: Clinical analysis and literature review of two cases of high-grade adult-type cervical embryonal rhabdomyosarcoma.

Background: Embryonal rhabdomyosarcoma (ERMS) predominantly occurs in children; primary cervical ERMS in adults is exceedingly rare and readily misdiagnosed, as its typical presentations-abnormal vaginal bleeding and a cervical mass-closely resemble gestational trophoblastic disease and uterine sarcomas. Case report: We present two cases of high-grade cervical ERMS in reproductive-age women; both presented \with abnormal vaginal bleeding and were diagnosed with stage IVB disease with regional lymph node metastasis at initial admission. Case 1 was complicated by synchronous bilateral pulmonary and multiple osseous metastases, while Case 2 exhibited a massive cervical tumor with extensive lymphatic dissemination. The two patients received distinct multimodal treatment regimens: one underwent primary surgery followed by adjuvant chemotherapy; the other received interventional embolization, neoadjuvant chemotherapy, radical resection, sequential chemoradiotherapy, and exploratory targeted maintenance therapy. Conclusion: Adult cervical ERMS is highly aggressive and prone to early distant spread. Immunohistochemical markers are mandatory to confirm the rhabdomyogenic origin of this tumor. For patients with advanced disease, multimodal regimens combining neoadjuvant chemotherapy, radical resection (when surgically feasible), and adjuvant chemoradiotherapy may serve as a primary comprehensive approach to potentially prolong overall survival. In patients with actionable somatic alterations identified through comprehensive molecular profiling and formal HRD testing, individualized exploratory targeted therapy may be explored only in highly selected patients. Further clinical investigations are warranted to refine treatment strategies and improve long-term outcomes.