Rare Case Of Synovial Sarcoma Research Articles

A Rare Case of Synovial Sarcoma with Bone Metastasis Mimicking Multiple Myeloma – Challenges of Management in a Nigerian Resource Constrained Setting

Background: Synovial sarcoma (SS), a rare carcinoma of soft tissues (including ligaments and muscles) around the big joints of the body, poses significant diagnostic and management challenges in low and middle income countries especially if it presented when metastasis had occurred. When there is metastasis to the bones, it mimics multiple myeloma on radiological skeletal survey. The objective of this report is to draw attention to this rare carcinoma which, usually, presents as a small painless nodule within the first three decades of life. We report this rare case of SS in a middle aged Nigerian lady who presented initially at National Orthopaedic Hospital (NOHE) with chronic severe right hip pain in which the initial radiological skeletal survey strongly suggested multiple myeloma. Definitive diagnosis and management of this case of synovial sarcoma was very challenging to the patient and managing unit. Conclusion: Early diagnosis of SS is critical at which point surgical excision or radiotherapy may be the preferred treatment option to achieve a favorable outcome. When metastasis is extensive, chemotherapy becomes the therapy of choice and it does not come cheap or easily available.

Chest Wall Monophasic Synovial Sarcoma in a 12-Year-Old Boy: A Case Report

We report a rare case of synovial sarcoma of the chest wall in a child. A 12-year-old male presented to our pediatric surgery department with chief complaint of swelling accompanied by slight pain of the upper right side of the anterior chest wall since approximately 5 months. Firstly, we performed an ultrasound (US)-mass biopsy. Histopathological examination showed fibromatosis. After that, we underwent surgical resection. Pathological examination revealed a monophasic type synovial sarcoma. Immediately post-operation, the patient manifested a loss of the extension of the forearm, hand, and fingers on the right side. Physical therapy was performed with good results. On the basis of our diagnosis, we performed 6 cycles of multi-drug adjuvant chemotherapy and then radiotherapy. After 3 years of surgery, there was no evidence of recurrence. However, careful observation may be required.

Chest Wall Monophasic Synovial Sarcoma in a 12-Year-Old Boy: A Case Report.

We report a rare case of synovial sarcoma of the chest wall in a child. A 12-year-old male presented to our pediatric surgery department with chief complaint of swelling accompanied by slight pain of the upper right side of the anterior chest wall since approximately 5 months. Firstly, we performed an ultrasound (US)-mass biopsy. Histopathological examination showed fibromatosis. After that, we underwent surgical resection. Pathological examination revealed a monophasic type synovial sarcoma. Immediately post-operation, the patient manifested a loss of the extension of the forearm, hand, and fingers on the right side. Physical therapy was performed with good results. On the basis of our diagnosis, we performed 6 cycles of multi-drug adjuvant chemotherapy and then radiotherapy. After 3 years of surgery, there was no evidence of recurrence. However, careful observation may be required.

A rare case of synovial sarcoma with lung, heart and adrenal gland metastasis: a caution for patients and clinicians

A 68-year-old man presented to the Urology Clinic, West China Hospital, Chengdu, with a suspected right adrenal gland mass that had persisted for two months. He had no associated lumbodynia, dizziness or palpitation. Abdominal computed tomography (CT) revealed an uneven density and contrast-enhanced oval-like mass with smooth edges in the right adrenal gland. Laparoscopic right adrenal gland resection followed by histopathology confirmed a diagnosis of metastatic synovial sarcoma. The patient had a history of synovial sarcoma on the right upper leg 3 years previously that was surgically treated, but he had not undergone further treatment. Approximately 1.5 years later, he had undergone surgery for heart and lung metastasis from the synovial sarcoma of the thigh. At 5 months following laparoscopic right adrenal gland resection, abdominal CT showed a significant sign of right adrenal recurrence, and targeted therapy of 12 mg oral anlotinib, daily, was initiated. This relatively rare but alarming case highlights the importance of patient understanding and compliance to treatment.

A Rare Case of Primary Synovial Sarcoma of Ovary: A Case Report

Synovial sarcoma is a malignant neoplasm predominantly of the young age arising from the soft tissues. It does not particularly arise from the synovial membrane and is capable of arising from any tissue. However, it arises most commonly from the para-articular tissue of the extremities. Here, we present a rare case of synovial sarcoma arising from the ovary which mimicked an epithelial ovarian neoplasm on clinical grounds. Our patient is a young 26-year-old unmarried lady who underwent investigations for abdominal pain and lump. She underwent adnexal mass excision, and the histopathology examination noted cells with bizarre nuclei and multinucleation with thick-walled interspersed arborizing vessels. The cells stained positive on IHC for pancytokeratin, CD99 (Figure 4), TLE 1 (Figure 5), FLI-1, CD 34 highlighting vessels and negative for desmin, p16, BCL2. FISH-SYT-SS18 was positive, and FISH-EWSR1 was negative. The pathological features suggested a synovial sarcoma. However, the unusual location of the tumor was worth noting. Although evidence for adjuvant treatment for this is bleak, she was advised adjuvant ifofhamide, but she refused treatment and has relapsed with distant metastasis within 4 months of surgery.

Challenges in Remote Cardiac Care; a Rare Cardiac Tumour

Introduction: Synovial sarcoma is a rare soft tissue malignancy that may present with secondary cardiac involvement. Multi-modal imaging is necessary for diagnosis and management requires specialist medical and surgical input. Many Indigenous Australians reside in remote locations with limited services. Accessing necessary healthcare can involve travelling great distances away from family and familiar surroundings. This case report describes a rare case of cardiac tumour with the added challenges faced by an Indigenous patient living in a remote location. Case report: A 52 year old indigenous male presented to an outreach cardiology clinic in a remote community with increasing dyspnoea. A history of synovial sarcoma excision seven years prior was noted. Transthoracic echocardiography revealed a large mass within the left ventricle, extending from the lateral wall, filling a portion of the chamber. The patient subsequently travelled to the closest tertiary hospital, several hundred kilometres away, for further investigation. He was then required to travel interstate for cardiac magnetic resonance imaging (CMR) and consideration of treatment options. The CMR demonstrated findings of malignant tumour invasion of the myocardium, most consistent with metastatic synovial sarcoma. The mass was considered inoperable and the patient was referred back to his closest hospital for palliative treatment closer to his family and community. Conclusion: This report demonstrates a rare case of synovial sarcoma with cardiac metastasis and the imaging modalities involved, as well as highlighting the difficulties faced by those living in remote locations to obtain necessary healthcare.

A rare case of synovial sarcoma of the neck with review of literature

Synovial sarcoma (SS) is a malignant tumor of pluripotent/undifferentiated cells. Only 3% of all SSs are found in the neck. We present a case of a 16-year-old male presenting neck swelling for 6 months which was diagnosed as biphasic SS of the neck on fine-needle aspiration cytology. Complete surgical resection with lateral partial pharyngectomy was done followed by postoperative radiotherapy. We also present the recent reviews on diagnosis and management on SS of head and neck.

Diagnostic dilemma of cardiac synovial sarcoma – Primary or secondary

Cardiac synovial sarcomas are rare tumors. Few cases are reported in literature. They commonly present with heart failure. Surgery is the primary modality of treatment where possible. Radiation and chemotherapy are used for local and systemic control as indicated. We present a rare case of synovial sarcoma with simultaneous cardiac and soft tissue involvement. The case is presented for its rarity and diagnostic difficulty in determining the primary site of origin.

Synovial Sarcoma of the Buccal Mucosa: A Rare Case Report

Synovial sarcoma (SS) is a rare malignant neoplasm that arises most commonly in joint capsules and articular tendons, but its relationship to the synovium is not always obvious. Synovial sarcoma is a malignant soft tissue tumor representing 5.6% to 10% of all soft tissue sarcomas. They are termed SS because of their histologic resemblance to the synovium, but they rarely involve a synovial structure and are thought to arise from pluripotential mesenchymal cells. The tumor usually occurs in close association with tendon sheaths, bursae, and joint capsules, primarily in the para-articular regions of the extremities, with approximately 9% occurring in the head and neck region. Synovial sarcoma has been reported rarely in the oral cavity. We report a very rare case of Synovial sarcoma of the buccal mucosa in a 24-year-old male patient.

Synovial sarcoma of the vulva: a case report

IntroductionContrary to its name, synovial sarcoma does not arise from the synovial membrane but from multipotent stem cells and can present in any part of the body. Very few cases of vulval synovial sarcoma have been reported in the literature; we report on such a presentation. These tumors can present as painless lumps, which must be completely excised to give the best prognosis. Therefore the diagnosis of synovial sarcoma should always be kept in mind in the management of vulval masses, especially in young patients.Case presentationWe report the case of a 28-year-old Caucasian woman with synovial sarcoma of the vulva. Complete excision was possible in this case.ConclusionWe have presented a rare case of synovial sarcoma of the vulva, which can be easily confused with lipoma of the vulva. The management of this tumor requires referral to a cancer centre, with a multidisciplinary approach.

Intraneural synovial sarcoma of the median nerve

Synovial sarcomas are soft-tissue malignancies with a poor prognosis and propensity for distant metastases. Although originally believed to arise from the synovium, these tumors have been found to occur anywhere in the body. We report a rare case of synovial sarcoma arising from the median nerve. To our knowledge, this is the twelfth reported case of intraneural synovial sarcoma, and only the fourth arising from the median nerve. Because the diagnosis may not be apparent until after pathological examination of the surgical specimen, synovial sarcoma should be kept in mind when dealing with what may seem like a benign nerve tumor.

Synovial sarcoma of the chest wall

We here report a rare case of synovial sarcoma of the chest wall. A 71-year-old Japanese woman noticed a left anterior chest wall mass after twice having had surgery for lung cancer. An aspiration biopsy diagnosed synovial sarcoma. She then underwent a surgical resection. Pathology examination revealed a biphasic-type synovial sarcoma. When the prepared RNA from the tumor was subjected to a polymerase chain reaction, SYT-SSX1 fusion gene transcripts were demonstrated. Patients with the SYT-SSX1 fusion gene have a worse clinical outcome than patients with SYT-SSX2-positive tumors. After a second surgery, performed in 1 year later, there was no evidence of recurrence for 30 months; however, careful observation may be required.

A rare case of synovial sarcoma of the prostate

Prostatic synovial sarcomas are exceedingly rare. To our knowledge, only six primary cases have been reported so far. We herein describe a primary synovial sarcoma of the prostate seen in a 25-year-old male patient, the youngest patient seen with this disease to date. He was referred to our department with the diagnosis of high-grade sarcoma of the prostate revealed by TRUS-guided biopsy. On admission he had a transurethral catheter for acute retention of urine. MRI revealed a solid prostatic tumor of 9.5 × 8 cm involving the rectum without any evidence of lymphatic or distant metastases. The patient underwent total pelvic exenteration and sigmoid end colostomy with ileal conduit. Histopathology revealed a synovial sarcoma of the prostate, immunoreactive to vimentin, Bcl-2 and cytokeratin. The patient is doing well at 18 months follow-up.

Well-differentiated Biphasic Synovial Sarcoma in the Atlanto-occipital Joint of a Holstein Cow

A 7-year-old Holstein cow developed a large cystic mass in the region between the atlantoaxis and larynx. The mass extended to the synovium in the atlanto-occipital joint. Many villous projections were present on the inner surface of the tumor tissue, and irregular clefts were formed in the inside. Two cell types, epithelioid-like synovioblasts and spindle cells, were present. Immunohistochemical analysis showed that the cells stained positively for cytokeratin (AE1/AE3) and vimentin. Both cells had similar fine structures ultra-structurally. Vacuoles present in the cytoplasm were full of an acid mucous substance. The tumor was diagnosed as a well-differentiated biphasic synovial sarcoma. This is the first report of a rare case of synovial sarcoma, from the viewpoint of its origin.

副咽頭間隙に発生した滑膜肉腫例

Synovial sarcomas occur primarily in the periarticular region and are predominantly located in the extremities. However, they can arise in the head and neck region. In the available Japanese literature, only 14 cases have been reported. We encountered a rare case of synovial sarcoma of the parapharyngeal space. Thus, we report this case with some consideration according to literature. The patient was a 15-year-old male with no clinical symptoms. Swelling of the right mesopharynx and soft palate was noted by his general practitioner at school. From the initial examinations of CT, MRI, Gallium-67 citrate scan and FNA, a malignant tumor of the parapharyngeal space with no metastasis was revealed. Then, an excisional biopsy was performed and the pathological diagnosis was SYNOVIAL SARCOMA (biphasic type). After the biopsy, the tumor rapidly spread to the oral cavity. Therefore, embolization of the right maxillary artery was performed to reduce the blood supply to the tumor. After the tracheostomy, radical surgery was performed using the mandibular swing maneuver, which enabled us to approach the tumor. Complete en-bloc resection of the tumor was carried out.During the operation, there was no significant association between the tumor and the mandibular joint. After the operation, adjuvant chemotherapy and radiotherapy were to be applied, but we were unable to obtain informed consent. Therefore, we decided to apply only radiotherapy (total 60Gy) on an out-patient basis. Although he has been alive and disease free for 8 months, it is necessary to check for local recurrence and lung metastasis regularly. Although the prognosis of the disease is not good, we can overcome this disease by means of cytogenetic therapy in the future.

Synovial sarcoma in the parapharyngeal space: case report and review of the literature

We encountered a rare case of synovial sarcoma in the parapharynx of a 47-year-old Japanese man. This patient presented with an enlarging tumor in the right side of his neck that had grown progressively over a 4-week period. Radiological examinations revealed that the tumor arose from the parapharyngeal space. The tumor could not be completely removed at surgery. Metastasis to the lumbar vertebra was detected postoperatively. The patient underwent three courses of chemotherapy and the delivery of palliative radiation to the lumbar vertebra without success. The patient died of lung metastasis 7 months after surgery.

Endolaryngeal Synovial Sarcoma

An extremely rare case of synovial sarcoma localized in the larynx is reported together with a review of 6 similar neoplasms previously reported in this unusual region. In this case, the patient is still tumor free 16 years after therapy.