Abstract
Synovial sarcoma (SS) is a high-grade, rare variant of soft tissue sarcoma (STS). The biphasic subtype is less common than the monophasic subtype. SS is very common around joint cavities in the extremities, but can be present elsewhere in the body. Tumor staging and therapeutic management are usually clear for a localized disease, but the proper management at the metastatic stage can be unclear. According to the literature, the histologic presence of an SS tumor thrombus affects tumor staging, making it unclear whether the tumor stage corresponds to localized or metastatic disease. An intravascular SS tumor exhibiting high metastatic potential is a rare finding that warrants thorough investigation.A 49-year-old woman presented with a biphasic SS intravascular tumor of the left inguinal area with femoral vessels involvement. Ten cases of intravascular SS have been reported in the literature and contain little information regarding the proper management of a local metastatic disease. Ours is a rare case of SS with an intravascular tumor occupying the femoral-iliac vein (as seen in metastatic disease) that has been treated as a local disease with a multidisciplinary therapeutic approach. As a result, our patient has been disease-free for two years and, during that time, has achieved an acceptable quality of life.We discuss the pertinent clinical findings of this rare tumor and review the literature of tumor thrombus by SS. We also present the multidisciplinary therapeutic approach realized and the history of this disease.
Highlights
Soft tissue sarcomas (STS) are rare tumors that develop in supporting tissues
We present the multidisciplinary therapeutic approach realized and the history of this disease
These tumors are known to arise in close joint cavities; they can occur at any site in the body [2]
Summary
Soft tissue sarcomas (STS) are rare tumors that develop in supporting tissues. Synovial Sarcoma (SS) accounts for 8 to 10% of all STSs, occurring slightly more often in men than women at a ratio of 1.2:1.0 [1,2]. We discuss a very rare case of histopathologically confirmed biphasic synovial sarcoma with intravascular tumor thrombus treated with a multidisciplinary therapeutic approach. Venous phase computed tomography with maximum intensity projection (MIP) reconstruction shows a heterogeneous nodular enhancement lesion in the lumen of the left superficial femoral vein (yellow arrow). Given the patient’s exceptional case, multiple recurrence risk factors, and the controversy around the use of adjuvant therapy for local metastatic disease, the sarcoma board recommended eight cycles of trabectedin for the patient. As of this writing, the patient is free of disease and undergoes frequent medical follow-ups.
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