In one patient with PAX3::FOXO1 fusion, the HGRT from a late recurrence 14 years since initial diagnosis overlapped epigenetically with embryonal rhabdomyosarcoma.<h4>Conclusion</h4>The epigenetic signature of BSNS is usually preserved in cases that underwent HGRT, even after many years from the initial onset of BSNS. Here, FOXO1 is linked to embryonal rhabdomyosarcoma.