Secondaries of Synovial Sarcoma in Vagina: A Diagnostic Dilemma

Abstract

Synovial sarcoma (SS) is a clinically, morphologically, and genotypically distinctive neoplasm, accounting for approximately 10% of soft tissue sarcomas, which usually afflicts young-to-middle-aged adults and typically occurs in the deep soft tissues of the extremities, particularly the thigh and knee regions. The aim of this study is to describe a case of metastatic synovial sarcoma of vaginal wall with primary in the thigh. This is the first report documenting its occurrence in the vagina as a metastatic tumour. This is the first case of vaginal synovial sarcoma in the Indian literature. A 57-year-old female presented with vaginal bleed. A thorough workup was done including clinical examination, histopathological examination of the biopsy from vaginal mass, IHC, and review of slides from the thigh swelling. A systematic literature review was conducted by searching the PubMed and National Centre for Biotechnology Information database. Physical examination revealed fleshy mass at the anterior vaginal wall and a thigh swelling. On histopathological examination of the vaginal mass followed by IHC, a diagnosis of synovial sarcoma was made and the slides of the thigh mass were reviewed which revealed similar morphology and IHC profile. Hence, a final diagnosis of synovial sarcoma of thigh with metastasis to vaginal wall was made. Four case reports of primary SS of the vagina were found on reviewing the literature. To the best of our knowledge, this is the first report documenting the occurrence of synovial sarcoma in the vagina as a metastatic tumour and overall fifth report to document its occurrence in the vagina. All other four previously reported cases were primary SS of the vagina.