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Zhang J, Findeis SK, Lang BJ, Ogola GO, Agarwal A. Primary rectal monophasic synovial sarcoma. Proc (Bayl Univ Med Cent) 2021; 34:512-516. [PMID: 34219943 DOI: 10.1080/08998280.2021.1902191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Synovial sarcoma is a rare malignant mesenchymal neoplasm that often occurs in the extremities. Less than 70 cases of primary synovial sarcoma occurring in the digestive system have been reported. We present a case of a 48-year-old woman with a spindle cell tumor in the rectum that stained positive for AE1/3 (focal), vimentin, CD99, BCL2, EMA (focal), and MiB-1 (15%). Ultimately, the lesion was diagnosed as a primary rectal monophasic synovial sarcoma and confirmed by molecular testing for SYT/SSX1 gene fusion. Analysis of previous publications indicated that patients of advanced age or a large tumor size (≥5 cm) have a higher risk of progressing rapidly to death after diagnosis of synovial sarcoma in the digestive system.
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Affiliation(s)
- Junlin Zhang
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Sarah K Findeis
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Benjamin J Lang
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Gerald O Ogola
- Baylor Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Atin Agarwal
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
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2
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Sasaki K, Noda M, Tsuruda Y, Uchikado Y, Omoto I, Kita Y, Arigami T, Mori S, Kurahara H, Nakajo A, Higashi M, Ohtsuka T. Primary monophasic synovial sarcoma of the cervical esophagus confirmed by detection of the SS18-SSX2 fusion transcripts: case report and literature review. Surg Case Rep 2020; 6:176. [PMID: 32691176 PMCID: PMC7371770 DOI: 10.1186/s40792-020-00940-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background Synovial sarcoma (SS) of the esophagus is extremely rare. Because of the microscopic features of SS, the monophasic type can easily be misdiagnosed as other spindle cell tumors. Here, we present the first case of a primary SS of the esophagus in the presence of SS18-SSX2 fusion transcripts. Case presentation A 47-year-old Japanese woman was initially diagnosed with thyroid papillary carcinoma in the left lobe and leiomyoma of the cervical esophagus and subsequently underwent left thyroid lobectomy and enucleation of the esophageal tumor. Four years after the first surgery, the esophageal tumor recurred. Endoscopic biopsy of the tumor revealed atypical cell proliferation with spindle cell features and mitoses. Immunohistochemistry showed focal positivity for bcl-2 and HHF35. Furthermore, the presence of SS18-SSX2 fusion transcripts was confirmed by reverse transcription-polymerase chain reaction analysis, using a paraffin-embedded tumor specimen. Therefore, the tumor was diagnosed as monophasic SS of the cervical esophagus. We re-evaluated the surgical specimen enucleated 3 years previously, which was initially diagnosed as leiomyoma, and the diagnosis of SS was confirmed. The patient underwent cervical esophagectomy with isolated jejunal interposition reconstruction. Three years after the second surgery, SS recurred in the distal anastomotic site between the jejunum and the esophagus, and the patient underwent thoracoscopic esophagectomy with gastric conduit reconstruction. The pathological grade of the lesion worsened with every recurrence. Conclusions Monophasic SS can be difficult to discriminate from other spindle cell tumors based on microscopy alone, and molecular analysis could be useful for confirming the precise diagnosis of monophasic SS.
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Affiliation(s)
- Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan.
| | - Masahiro Noda
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Yusuke Tsuruda
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Yasuto Uchikado
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Itaru Omoto
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Yoshiaki Kita
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Takaaki Arigami
- Department of Onco-Biological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Michiyo Higashi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
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Ioannidis A, Koutserimpas C, Papatsoris A, Argyrou A, Deliveliotis H, Velimezis G, Dimopoulos AM. Monophasic synovial sarcoma as a cause of obstructive ileus: A case report. Mol Clin Oncol 2018; 10:185-187. [PMID: 30655996 DOI: 10.3892/mco.2018.1768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/30/2018] [Indexed: 01/14/2023] Open
Abstract
Synovial sarcoma is a high-grade soft tissue sarcoma, divided histologically into 3 types: Monophasic, biphasic and poorly differentiated. An extremely rare case of obstructive ileus due to monophasic synovial sarcoma in a 54-year-old male patient is reported in the present study. The patient presented to the emergency department with signs and symptoms of obstructive ileus. Computer Tomography (CT)scan showed a pelvic mass (20×17×12 cm) causing obstruction at the sigmoid colon. An exploratory laparotomy through a midline incision was performed. The described mass was unresectable as it was infiltrating major vessels. Therefore, a diverting loop descending colostomy and biopsy of the solid mass were performed. Pathological examination revealed a monophasic synovial sarcoma. The patient was referred to the Department of Oncology and started treatment with doxorubicin and ifosfamide.
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Affiliation(s)
- Argyrios Ioannidis
- Second Department of Surgery, Sismanoglio General Hospital of Athens, 15126 Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopedics and Traumatology, '251' Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece
| | - Athanasios Papatsoris
- Second University Department of Urology, National and Kapodistrian University of Athens School of Medicine, Sismanoglio General Hospital of Athens, 15126 Athens, Greece
| | - Alexandra Argyrou
- Department of Basic Medical Sciences, Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Haralampos Deliveliotis
- Second University Department of Urology, National and Kapodistrian University of Athens School of Medicine, Sismanoglio General Hospital of Athens, 15126 Athens, Greece
| | - Georgios Velimezis
- Second Department of Surgery, Sismanoglio General Hospital of Athens, 15126 Athens, Greece
| | - Athanasios-Meletios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, 11528 Athens, Greece
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4
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Mege D, Depypere L, Piessen G, Slaman AE, Wijnhoven BPL, Hölscher A, Nilsson M, van Berge Henegouwen MI, van Lanschot JJB, Schroeder W, Thomas PA, Nafteux P, D'Journo XB. Surgical management of esophageal sarcoma: a multicenter European experience. Dis Esophagus 2018; 31:4850444. [PMID: 29444281 DOI: 10.1093/dote/dox146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
Esophageal sarcomas are rare and evidence in literature is scarce making their management difficult. The objective is to report surgical and oncological outcomes of esophageal sarcoma in a large multicenter European cohort. This is a retrospective multicenter study including all patients who underwent en-bloc esophagectomy for esophageal sarcoma in seven European tertiary referral centers between 1987 and 2016. The main outcomes and measures are pathological results, early and long-term outcomes. Among 10,936 esophageal resections for cancer, 21 (0.2%) patients with esophageal sarcoma were identified. The majority of tumors was located in the middle (n = 7) and distal (n = 9) third of the esophagus. Neoadjuvant chemoradiotherapy was performed in five patients. All the patients underwent en-bloc transthoracic esophagectomy (19 open, 2 minimally invasive). Postoperative mortality occurred in 1 patient (5%). One patient received adjuvant chemotherapy. Definitive pathological results were carcinosarcoma (n = 7), leiomyosarcoma (n = 5), and other types of sarcoma (n = 9). Microscopic R1 resection was present in one patient (5%) and seven patients (33%) had positive lymph nodes. Median follow-up was 16 (3-79) months in 20 of 21 patients (95%). One-, 3-, and 5-year overall survival rates were 74%, 43%, and 35%, respectively. One-, 3- and 5-years disease-free survival rates were 58%, 40%, and 33%, respectively. Median overall survival was 6 months in N+ patients vs. 37 months for N0 patients (p = 0.06). At the end of the follow-up period, nine patients had died from cancer recurrences (43%), three patients died from other reasons (14%), one patient was still alive with recurrence (5%) and the seven remaining patients were free of disease (33%). Recurrence was local (n = 3), metastatic (n = 3), or both (n = 4). In conclusion, carcinosarcoma and leiomyosarcoma were the most common esophageal sarcoma histological subtypes. Lymph node involvement was seen in one third of cases. A transthoracic en-bloc esophagectomy with radical lymphadenectomy should be the best surgical option to achieve complete resection. Long-term survival remained poor with a high local and distant recurrence rate.
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Affiliation(s)
- D Mege
- Department of Thoracic and Esophageal Surgery, Marseille
| | - L Depypere
- Department of Thoracic Surgery, Leuven, Belgium
| | - G Piessen
- Department of Digestive and Oncological Surgery, Lille, France
| | - A E Slaman
- Department of Surgery and Amsterdam Cancer Center, Amsterdam
| | - B P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - M Nilsson
- Department of Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - J J B van Lanschot
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - P A Thomas
- Department of Thoracic and Esophageal Surgery, Marseille
| | - P Nafteux
- Department of Thoracic Surgery, Leuven, Belgium
| | - X B D'Journo
- Department of Thoracic and Esophageal Surgery, Marseille
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5
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Murro D, Slade JM, Syed S, Gattuso P. Fine needle aspiration of secondary synovial sarcoma of the thyroid gland. Diagn Cytopathol 2015; 43:928-32. [DOI: 10.1002/dc.23327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/24/2015] [Accepted: 08/05/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Diana Murro
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | | | - Sahr Syed
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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6
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de Alencar MHL, Boldrini D, Costa ADM, Torres de Oliveira AT, Attab CS. [Primary synovial sarcoma of the esophagus]. Rev Col Bras Cir 2013; 39:441-3. [PMID: 23174799 DOI: 10.1590/s0100-69912012000500018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 05/20/2007] [Indexed: 02/05/2023] Open
Abstract
Synovial sarcomas are uncommon malignant mesenchymal tumors occurring mainly near the joints of the extremities of young adults. Synovial sarcomas are exceedingly rare neoplasms of the digestive tract. We report the first diagnosed case of esophageal synovial sarcoma, highlighting its diagnostic features surgical management and follow-up.
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7
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Synovial sarcoma in cerebellum: a case report and literature review. Brain Tumor Pathol 2012; 31:68-75. [DOI: 10.1007/s10014-012-0126-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
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8
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Wang CC, Wu MC, Lin MT, Lee JC. Primary gastric synovial sarcoma. J Formos Med Assoc 2012; 111:516-20. [DOI: 10.1016/j.jfma.2012.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 10/01/2009] [Accepted: 11/30/2009] [Indexed: 10/27/2022] Open
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9
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Lin YJ, Yang QX, Tian XY, Li B, Li Z. Unusual primary intracranial dural-based poorly differentiated synovial sarcoma with t(X; 18)(p11; q11). Neuropathology 2012; 33:75-82. [DOI: 10.1111/j.1440-1789.2012.01320.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Alsharief AN, Fageeh M, Alabdulkarim Y. Monophasic synovial sarcoma presenting as a primary ileal mass: a case report and review of the literature. J Med Case Rep 2012; 6:83. [PMID: 22413892 PMCID: PMC3310833 DOI: 10.1186/1752-1947-6-83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Synovial sarcoma is a rare malignant mesenchymal tumor mainly arising in the peri-articular tissue in young adults. There are few cases reported in other areas. CASE PRESENTATION We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction. A literature review was performed to gather information on this rare gastrointestinal tract sarcoma. CONCLUSIONS Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract. We believe the reporting of all rare or unexpected presentations of sarcoma will eventually improve our understanding of this relatively unusual malignancy.
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Affiliation(s)
- Alaa N Alsharief
- King Fahad Medical City, Riyadh, Saudi Arabia, P,O, Box 59046, Riyadh 11525 Kingdom of Saudi Arabia.
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11
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Rare Cause of Stricture Esophagus-Sarcoma: A Case Report and Review of the literature. Case Rep Gastrointest Med 2011; 2011:192423. [PMID: 22606414 PMCID: PMC3350176 DOI: 10.1155/2011/192423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/20/2011] [Indexed: 12/04/2022] Open
Abstract
Adenocarcinoma and squamous cell carcinoma account for the vast majority of oesophageal malignancies. Other malignancies known to occur in the oesophagus include melanoma, sarcoma, and lymphoma. Among the sarcomas, carcinosarcoma is the commonest with both carcinomatous and sarcomatous elements followed by leiomyosarcoma of mesenchymal origin. Other sarcomas reported in the literature are liposarcoma, synovial sarcoma, myxofibrosarcoma, Ewing's sarcoma, granulocytic sarcoma, histiocytic sarcoma, schwannoma rhabdomyosarcoma, and epithelioid sarcoma. We report a case of malignant spindle cell tumour of oesophagus. Sarcomas of esophagus present as a polypoid exophytic soft tissue mass. Our patient presented with a stricture which is a rare presentation. Locally aggressive treatment with surgery is beneficial, and local palliative treatment including radiotherapy is worthwhile.
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12
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Johnson AD, Pambuccian SE, Andrade RS, Dolan MM, Aslan DL. Ewing sarcoma and primitive neuroectodermal tumor of the esophagus: report of a case and review of literature. Int J Surg Pathol 2008; 18:388-93. [PMID: 18499684 DOI: 10.1177/1066896908316903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study presents a case of Ewing sarcoma and primitive neuroectodermal tumor arising in the esophagus of a 44-year-old woman who presented with progressive dysphagia. Imaging studies demonstrated a polypoid lesion in the esophagus. The tumor was characterized by corded and pseudopapillary architecture, cytologic monotony, and low proliferative activity. Immunohistochemical stains were positive for CD99, neuron-specific enolase, vimentin, cyclin D1, p53, and FLI1 gene product. Fluorescence in situ hybridization demonstrated a 22q12 translocation, associated with primitive neuroectodermal tumor in the tumor cells, whereas reverse transcription polymerase chain reaction conformed expression of Ewing sarcoma/FLI1 fusion transcript in the patient's bone marrow aspirate. Although this is a rare site for this type of tumor to occur, primitive neuroectodermal tumor should be considered in the differential diagnosis of mesenchymal tumors of the esophagus. Genetic analysis is crucial to establish the diagnosis and can be successfully performed on formalin-fixed, paraffin-embedded material and hematopoietic tissue.
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Affiliation(s)
- Andrew D Johnson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
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Schreiber-Facklam H, Bode-Lesniewska B, Frigerio S, Flury R. Primary monophasic synovial sarcoma of the duodenum with SYT/SSX2 type of translocation. Hum Pathol 2007; 38:946-9. [PMID: 17509396 DOI: 10.1016/j.humpath.2007.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/04/2006] [Accepted: 01/11/2007] [Indexed: 01/09/2023]
Abstract
Recent findings on the molecular background of synovial sarcoma with the description of the specific translocation t(X;18) led to the incorporation of this particular genetic aberration into the definition of this tumor type. Synovial sarcomas with proven diagnostic translocation are being described with increasing frequency in unsuspected locations not related to joints, such as lung, pleura, heart, or pharynx. The gastrointestinal tract has been rarely reported as a primary site of synovial sarcomas with rare cases in the esophagus and stomach. We report a case of a primary synovial sarcoma of the distal duodenum with SYT/SSX2 type of the t(X;18) translocation. Primary spindle cell neoplasms of the duodenum are rare and consist mostly of gastrointestinal stromal tumors, which are amenable to the therapy with Gleevec. Synovial sarcoma widens the differential diagnosis of mesenchymal tumors of the intestine.
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