Metastatic Breast Tumor Arising from Synovial Sarcoma: Report of a Case

We report a case of metastatic breast tumor arising from a synovial sarcoma of the lower limb. A 27-year-old Japanese woman was diagnosed to have synovial sarcoma 14 months prior to finding a mass in her left breast. An excisional biopsy was performed and a metastatic synovial sarcoma to the breast was confirmed. Eight months after the resection of the breast lesion, the patient developed local recurrences in both her knee and breast. A tumor resection of the limb lesion and a simple mastectomy for the huge lesion, which was diagnosed to be a metastatic breast tumor without lymph node metastasis, were performed. After the operation, the patient received adjuvant systemic chemotherapy. To the best of our knowledge, this is only the second reported case of a solitary metastatic breast tumor arising from synovial sarcoma.     

Synovial Sarcoma: A Case Report

The case described, of a 40-year-old woman with a 26-year history of a chronic, non-specific knee disorder, is a rather typical example of synovial sarcoma, according to the information given by other authors over the past three to four decades. The diagnostic difficulties and failures are clearly illustrated. It must be emphasized that severe, obscure joint symptoms such as our patient presented over the many years before death should have led to a proper surgical exploration of the knee. Furthermore, it should be unnecessary to stress the importance of performing a histological examination whenever excising abnormal tissue.     

Spontaneous Pneumothorax Secondary to Radiographically Occult Lung Metastasis from Parapharyngeal Synovial Sarcoma: Report of a Case

This report describes a case of secondary pneumothorax caused by a radiographically occult lung metastasis from parapharyngeal synovial sarcoma, a relatively rare tumor known to be highly metastatic to the lung. Although chest X-ray and thoracic computed tomography scan failed to detect the metastatic nodule in the right lung, the surgically resected specimen proved to be a 3-mm lung metastasis. To our knowledge, only eight cases of lung metastases from synovial sarcoma causing pneumothorax have ever been reported. In most of these cases, the lung metastases were detected by radiographical examinations. However, in this patient, the metastatic lesion was not detected during examination. It is speculated that secondary pneumothorax caused by synovial sarcoma may occur during the early stages of lung metastasis. Therefore, if pneumothorax occurs in a patient with a synovial sarcoma, the possibility of lung metastasis should be carefully considered, even if it is undetectable on radiological examinations. Received: February 7, 2001 / Accepted: September 11, 2001     

The Value of Immunohistochemistry in Diagnosing Primary Renal Synovial Sarcoma: A Case Report and Literature Review

Primary synovial sarcoma of the kidney is rare and difficult to diagnose with 100% accuracy without the use of up-to-date histopathologic methods. Immunohistochemical procedures are well established and are continuously expanding and improving. Currently, these methods are successful in up to 90% of tumor identification. The remaining cases will ultimately benefit by combining immunohistochemistry with tumor-specific genetic marker identifiers, the latter of which are increasing in availability for tumor diagnosis. The principal immunohistochemical methods enlisted in establishing a diagnosis of primary renal synovial sarcoma are summarized.     

Gouty Tophi in Sinus Tarsi of Bilateral Feet Mimicking Synovial Sarcoma:A Case Report

Chronic gout is defined as accumulation of monosodium urate crystals in joints, cartilage, tendons, bursae, bone, and soft tissue. The foot is the most common location for acute gout flares, with the first metatarsophalangeal joint being the most frequent site of tophus formation. However, few studies have reported gouty tophus formation in the subtalar joint. Gout has been termed the “great mimicker” because of its tendency to mimic other pathologic conditions, such as pigmented villonodular synovitis and synovial sarcoma. Herein, we present a rare case of chronic tophaceous gout in the sinus tarsi in both feet in a 23-year-old healthy male, with extensive bony erosions mimicking pigmented villonodular synovitis and synovial sarcoma. We discuss the clinical presentation, distinguishing radiologic characteristics, surgical procedures, and outcome regarding this unique presentation.     

Synovial sarcoma of the esophagus: Report of a case

(Received for publication on Aug. 9, 1996; accepted on May 12, 1997)     

Molecular and Clinicopathological Findings in a Tonsillar Synovial Sarcoma. A Case Study and Review of the Literature

Synovial sarcoma (SS), 3–5% of which occurs in the head and neck region, has generally been regarded as high grade sarcoma. Recent analysis of clinical, morphological, and molecular characteristics of SS, however, identified low and high risk group of patients, resulting in important implications for the treatment of patients diagnosed with SS. We describe the case of a 31-year-old male who presented with biphasic SS with poorly differentiated areas (clinical stage IIA) in a palatine tonsil, an extremely rare site of SS. Molecular analyses revealed typical t(X;18) translocation of the SYT gene and a SYT/SSX1 fusion type. The tumor was surgically resected with free margins. Adjuvant radiotherapy or chemotherapy was not considered indicated. To date, the patient has remained free of tumor for 4 years after surgery. Literature review reveals that primary tonsillar HNSS has previously been documented only in three patients. In all of these patients the tumor was histologically biphasic; however only one published case and the case presented here showed areas of poor differentiation. We discuss the relevance of the presented findings with regard to prognostic and therapeutic considerations in SS in the head and neck region.     

Management of Monophasic Synovial Sarcoma of the Small Intestine

Background:

Reports of primary intraabdominal synovial sarcomas are extremely rare.

Methods:

A literature review using PubMed was performed. A retrospective review of the one known case at our institution was completed.

Results:

Even the most experienced pathologists report that synovial sarcomas can be very difficult to diagnose correctly. One cytogenic abnormality that is common (>90%) and pathognomonic for synovial sarcoma is a characteristic chromosomal translocation resulting in the SYT/SSX fusion gene. Wide regional excision has been performed for intraabdominal sarcoma, with improved results. Our patient is more than 24 months with no evidence of recurrent or metastatic disease.

Conclusions:

The prognosis for patients with intraabdominal synovial sarcoma remains poor. However, wide regional excision may allow for prolonged disease-free survival.     

Amyloid Tumor in the Anterior Mediastinum: Report of a Case

A 33-year-old woman being treated for rheumatoid arthritis was referred to our hospital for investigation of a mediastinal mass. A chest computed tomography scan showed an anterior mediastinal mass, 8.5 × 7.0cm in size, with a cystic lesion and calcification. These findings were suggestive of either a noninvasive thymoma or a mature teratoma. Therefore, we performed tumor resection and thymectomy. Histologically, the tumor consisted of diffuse deposits of massive eosinophilic amorphous material. The tumor was stained red-orange by Congo red, and the staining disappeared following potassium permanganate digestion. Based on these findings, a diagnosis of reactive amyloidosis of the amyloid A-protein-derived type was made. Amyloidosis in the mediastinum has rarely been described.     

Multicystic Mesothelial Cyst of the Mediastinum: Report of a Case

We report the rare case of a multicystic mesothelial cyst of the mediastinum. A 43-year-old man was referred to our department after a routine chest X-ray showed an anterior mediastinum mass. The lesion was resected by thoracoscopy, which revealed multicystic, thin-walled tense masses arising in the anterior mediastinum. The cysts were not adherent to the pericardium or to the thymus of the right lobe. Immunohistochemistry revealed that the cyst was lined with a layer of mesothelial cells and there were no malignant foci. The lining cells were positive for keratin and negative for the lymphocyte marker. These findings were consistent with a diagnosis of multicystic mesothelial cyst. Received: March 19, 2002 / Accepted: July 2, 2002 Acknowledgment. We would like to thank Ms. Miyazaki for her excellent technical assistance in pathology. Reprint requests to: H. Sasaki     

Isolated Amyloid Tumor in the Mediastinum: Report of a Case

Primary amyloidosis isolated in the mediastinum is rarely encountered in thoracic surgery and few such cases have been reported. We present a case of primary isolated hilar amyloidosis of the mediastinum to illustrate the difficulties in differentiating this disorder preoperatively from central bronchial carcinoma, carcinoid tumor, and mediastinal lymphoma. Usually, a definitive diagnosis can only be made by open biopsy during thoracoscopy or thoracotomy. In conclusion, amyloidosis should be considered in the differential diagnosis of patients when calcifications are found, bearing in mind that radiologic findings are inconclusive and transbronchial biopsy can be negative. Received: August 3, 2001 / Accepted: July 2, 2002 Reprint requests to: J. Ordemann     

Distinct Clinical Characteristics of Unplanned Excision in Synovial Sarcoma

Background

We aimed to describe the clinical characteristics and outcomes of unplanned excisions of synovial sarcomas.

Methods

In total, 90 patients with synovial sarcomas in the extremities were retrospectively reviewed. Patients were divided into unplanned excision (n = 38) and planned excision (n = 52) groups. The average follow-up period was 6 years. The clinicopathological characteristics and oncologic outcomes were compared.

Results

The unplanned excision group showed longer duration of symptoms before diagnosis (p = 0.023), smaller lesion dimensions (p = 0.001), superficial location (p = 0.049), and predilection in the upper extremities (p = 0.037). Synovial sarcomas were most commonly misdiagnosed as neurogenic tumors (56%) in the upper extremities or as cystic masses (47%) in the lower extremities. Oncological outcomes, including disease-specific survival, metastasis-free survival, or local recurrence were not significantly different between the 2 groups (p = 0.159, p = 0.444, and p = 0.335, respectively). Repeated unplanned excision (p = 0.012) and delayed re-excision (p = 0.038) were significant risk factors for local recurrence in the unplanned excision group.

Conclusions

Synovial sarcomas treated with unplanned excision had distinct characteristics. These findings are important for developing diagnostic and therapeutic strategies for synovial sarcoma.     

Neurilemoma Originating from the Left Recurrent Nerve in the Superior Mediastinum: Report of a Case

We report a rare case of neurilemoma originating from the left recurrent nerve in the superior mediastinum.     

Anterior Endoscopy Combining with Modified Total En Block Spondylectomy for Synovial Sarcoma in Thoracic Paraspine Causing Neurological Deficits: Case Report and Literature Review

Anterior Endoscopy Combining with Modified Total En Block Spondylectomy for Synovial Sarcoma in Thoracic Paraspine Causing Neurological Deficits     

Primary Synovial Sarcoma of the Pharynx: A Series of Five Cases and Literature Review

Synovial sarcoma comprises approximately 10 % of all soft tissue sarcomas. Although synovial sarcoma has been reported in practically every organ, the extremities are the commonest site of occurrence followed by the head and neck. Primary synovial sarcoma of the pharynx is rare and only case reports have been published. We report a series of five cases of primary synovial sarcoma involving the pharynx.     

Synovial sarcoma of the hypopharynx in a pediatric patient: Case report

IntroductionSynovial sarcoma (SS) is uncommon high grade soft tissue sarcoma, accounting for less than 10% of all head and neck sarcomas. Also, about 10% of SS occur within the Head & Neck. In the pediatric population, SS is an extremely rare head & neck malignancy.Presentation of caseWe present a case of sixteen years old boy diagnosed with SS situated of the hypopharynx treated by surgical excision and post operative radio-chemotherapy.DiscussionThis anatomical location brings additional functional challenges (swallowing, phonation, respiration), especially in the pediatric population. Pre-operative and even post-operative histopathological diagnosis of SS remains difficult. Optimal treatment of Head & Neck SS has to balance functional and oncologic aspects.ConclusionSS is an extremely rare head & neck malignancy in pediatric population. It has multifaceted challenges including pre and post-operative histopathological diagnosis and optimal modality of treatment. Clinical judgment, especially in the pediatric population, needs to balance tumor free margins and organ preservation in head and neck region.     

横结肠系膜滑膜肉瘤1例

正患儿男,15岁,5天前无明显诱因出现持续性左下腹疼痛,无放射痛,伴睡眠较差,体质量下降3kg,饮食及大小便正常;既往体健,无家族性遗传病史。查体:触诊墨菲征阳性,余未见明显异常。实验室检查:白细胞11.90×109/L,中性粒细胞8.54×109/L,纤维蛋白原5.50g/L,D-二聚体5.93mg/L。腹部CT:胆囊壁增厚、毛糙,左下腹部6.6cm×9.2cm×10.0cm团块状软组织肿块,平扫CT值约49 HU(图1A),挤压周围脏器,邻近肠管粘连、紊乱,结构显示不清,未见梗阻征象;增强后肿块动脉期CT值约74 HU(图1B),静脉期CT值约78 HU,     

Successful Resection of a Primary Liposarcoma in the Anterior Mediastinum in a Child: Report of a Case

Primary liposarcomas of the mediastinum are very rare. We report on a 13-year-old girl who presented with a huge mediastinal tumor. The tumor was extirpated by a median sternotomy with a right thoracotomy. The tumor included the superior vena cava in the anterior mediastinum. It therefore probably originated from the anterior mediastinal fat tissue, possibly from the thymus. A pathological examination revealed myxoid liposarcoma. At 35 months postoperatively, the patient has not shown any recurrence. Received: March 15, 2000 / Accepted: September 26, 2000