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Vuong M, Mejbel HA, Mackinnon AC, Roden D, Suster DI. Nodular Fasciitis of the Buccal Mucosa with a Novel USP6 Gene Rearrangement: A Case Report and Review of the Literature. Head Neck Pathol 2024; 18:79. [PMID: 39167308 PMCID: PMC11339223 DOI: 10.1007/s12105-024-01687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
Nodular fasciitis is a rare but benign fibroblastic proliferation that typically presents as a solitary lesion with rapid growth and variable mitotic activity. The lesions usually occur on the extremities and occasionally in the head/neck region. Involvement of the buccal mucosa is extremely rare with only few reports in the literature; in this case report, we describe a 41 year old female who presented with a 6-month history of a stable intraoral lump at the junction of the upper and lower lip. Fine needle aspiration revealed an atypical spindle cell population with plump cells. The surgical excision demonstrated a well circumscribed tan-white firm nodule. Histologic examination revealed a spindle cell proliferation that grew in short, intersecting fascicles with focal storiform architecture. The lesion had a pushing border that was not overtly infiltrative and the stroma contained focal myxoid changes giving a "tissue culture" appearance to the cells. Immunohistochemical testing showed the tumor cells were vimentin (+), SMA (+), weakly Calponin (+), and desmin (-), cytokeratin (-), AE1/AE3 (-), S100 (-), ALK (-), STAT6 (-), and beta-catenin (-). Fluorescence in-situ hybridization (FISH) revealed a USP6 gene rearrangement with an atypical probe pattern. Next generation sequencing identified a novel SPTAN1::USP6 fusion gene confirming the diagnosis of buccal nodular fasciitis. Identification of the characteristic histologic features and USP6 gene rearrangements helped support the diagnosis. A review of the literature identified 25 cases of nodular fasciitis involving the buccal mucosa. The occurrence of this tumor in an unusual location may pose difficulties for diagnosis.
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Affiliation(s)
- Mallissa Vuong
- Department of Pathology, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07103, USA
| | | | | | - Dylan Roden
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David I Suster
- Department of Pathology, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07103, USA.
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2
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Imajo I, Yamada T, Chikui T, Kiyoshima T, Ito M, Kohashi K, Sakamoto E, Oda Y. Intraosseous synovial sarcoma of the mandible: A case report and review of the literature. Oncol Lett 2023; 26:318. [PMID: 37332332 PMCID: PMC10272957 DOI: 10.3892/ol.2023.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Synovial sarcoma (SS) is a malignant soft tissue tumor that usually arises in the para-articular regions of the extremities. Only nine cases of SS in the mandible have been reported to date. The present study described a case of SS arising from the left mandible. A 54-year-old woman was referred to Kyushu University Hospital (Fukuoka, Japan) with a complaint of numbness in the left mental nerve area. Computed tomography revealed replacement of the left mandibular bone marrow with soft tissue and destruction of the mandibular canal. Magnetic resonance imaging revealed an isointense mass on T1-weighted images and hyperintensity on T2-weighted images. The tumor showed homogeneous enhancement. A biopsy was performed, and monophasic SS was diagnosed based on immunohistochemical staining features and genetic analysis. Hemimandible dissection and supraomophyoid neck resection were performed with fibular osteocutaneous flap reconstruction, followed by adjuvant chemotherapy. There was no evidence of recurrence or distant metastases. The present study also reviewed the clinical, imaging, histological, and immunohistochemical features of the SS in the mandible.
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Affiliation(s)
- Ikumi Imajo
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomohiro Yamada
- Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Toru Chikui
- Oral and Maxillofacial Radiology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tamotsu Kiyoshima
- Laboratory of Oral Pathology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Mamoru Ito
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Pathological Science, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Eiji Sakamoto
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Science, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
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3
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Al Hayek M, Yousfan A. Monophasic synovial sarcoma in the temporomandibular joint region: A case report and review of the literature. Int J Surg Case Rep 2023; 105:107998. [PMID: 36966715 PMCID: PMC10066519 DOI: 10.1016/j.ijscr.2023.107998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Synovial sarcoma is a malignant neoplasm that arises from soft tissue and makes up 5 % to 10 % of all types of sarcoma. It is most common between the ages of 15 and 40; it typically develops in the lower extremities; just 3 % to 10 % of cases arise in the head and neck. The usual main areas in the head and neck are the parapharyngeal, hypopharyngeal, and paraspinal. CASE PRESENTATION An 18-year-old woman presented with a painful mass in the left pre-auricular area. CLINICAL DISCUSSION Magnetic resonance imaging showed a well-defined lobular mass localized superior and anterior to the left ear. Incisional biopsy showed spindle cell sarcoma. A preauricular incision was done to remove the tumor with the superficial lobe of the parotid gland during the procedure, and histological examination revealed a high-grade spindle cell sarcoma the differential diagnosis included a monophasic synovial sarcoma. Immunohistochemistry was done for a full evaluation and the panel supported diagnosing a monophasic synovial sarcoma. CONCLUSION Synovial sarcoma is a malignant tumor that is rare to develop in the temporomandibular region, which makes it a significant challenge to diagnose and differentiate it from other lesions, it should be considered in all patients with a mass in this region. The cornerstone to identify synovial sarcoma is Immunohistochemistry (IHC), and molecular genetic analyses. Total surgical excision, with or without radiation and chemotherapy, is currently the best option for treatment. We present a review of the literature after the case presentation.
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Affiliation(s)
- Mohammad Al Hayek
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
| | - Abdulmajeed Yousfan
- Department of Otolaryngology, Al Mouwasat University Hospital, Damascus University, Damascus, Syrian Arab Republic
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4
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Quan H, Sreekissoon S, Wang Y. Synovial sarcoma of the head and neck: A review of reported cases on the clinical characteristics and treatment methods. Front Cell Dev Biol 2022; 10:1077756. [PMID: 36684451 PMCID: PMC9853006 DOI: 10.3389/fcell.2022.1077756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/12/2022] [Indexed: 01/08/2023] Open
Abstract
Synovial sarcoma (SS) is a high-grade soft-tissue sarcoma that occurs predominantly in older children and young adults in their thirties. It is usually very challenging to diagnose and treat synovial sarcoma in the head and neck region. The purpose of this review is to investigate the clinical manifestations and different treatment methods in the management of primary synovial sarcoma of the head and neck. HNSS has an aggressive nature and poor prognosis. Surgical resection, radiotherapy, and chemotherapy are the primary treatment methods. Typically, surgical resection with negative margins remains the foundation of therapy, which is not very easily achieved in the head and neck due to its complex anatomical structure and the presence of many blood vessels and nerves. However, synovial sarcoma has a high recurrence rate, so aggressive management and close follow-up are warranted for the optimal outcome.
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Affiliation(s)
- Hongzhi Quan
- Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital and School of Stomatology, Central South University, Changsha, Hunan, China
| | - Senjeet Sreekissoon
- Department of Oral Maxillofacial Surgery, Xiangya Stomatological Hospital and School of Stomatology, Central South University, Changsha, Hunan, China
| | - Yan Wang
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
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5
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Biphasic synovial Sarcoma with extensive calcification in the temporomandibular joint region: A rare case report and literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:592-598. [DOI: 10.1016/j.jormas.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022]
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6
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Wang Y, Zhu F, Wang K. Synovial sarcoma of the floor of the mouth: a rare case report. BMC Oral Health 2020; 20:5. [PMID: 31906928 PMCID: PMC6945757 DOI: 10.1186/s12903-019-0961-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Head and neck Synovial sarcoma (SS) accounts for 3–10% of all total body SS. It is rare to find it in the oral cavity, especially on the floor of the mouth. Case presentation We present a 44-year-old Chinese male, who had been misdiagnosed as fibroadenoma, with a swelling on the right submandibular region for more than 3 months. The radiology examinations and the pathology results indicate the diagnosis of SS of the floor of the mouth. The patient only had a surgical operation, without radiotherapy and chemotherapy. At the first follow-up, the patient exhibited no clinical or radiographic complications, and the patient was asymptomatic on subsequent visits. Conclusions Misdiagnosis results the delay of diagnosis and treatment of SS. Immunohistological analysis might be the most important tool to confirm the diagnosis of SS.
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Affiliation(s)
- Yannan Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, 410011, Hunan, China
| | - Feiya Zhu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, 410011, Hunan, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Renmin Road, No 139, Changsha, 410011, Hunan, China.
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7
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Romero N, Mulcahy CF, Barak S, Shand MF, Badger CD, Joshi AS. Synovial osteochondromatosis of the temporomandibular joint: A case report. World J Otorhinolaryngol 2019; 8:12-18. [DOI: 10.5319/wjo.v8.i2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/26/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial osteochondromatosis is a rare but benign condition that can result in significant impairment of joint functionality. This case report documents an uncommon presentation of this disorder occurring within the temporomandibular joint, causing the patient significant pain, trismus, and difficulty with daily activities such as eating and speaking. A review of the literature including disease mechanisms and previously documented cases is included to provide comprehensive background for clinical decision-making.
CASE SUMMARY A 48-year-old male patient presented with a 3-mo history of trismus, crepitus with jaw movement and significant pain while chewing. Physical examination revealed a firm mass and tenderness to palpation at the right temporomandibular joint. Further workup revealed a bilobed mass extending into the joint space as well as significant bony erosion of the glenoid fossa. The patient underwent mass excision with joint reconstruction and pathology revealed synovial osteochondromatosis. The patient reported significant improvement in his symptoms postoperatively.
CONCLUSION This report outlines the investigative approach and treatment course of synovial osteochondromatosis. The positive outcome following surgical intervention in this case emphasizes the importance of interdisciplinary collaboration and the potential for improvement in quality of life of this patient population.
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Affiliation(s)
- Nahir Romero
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, George Washington University Hospital, Washington, DC 20037, United States
| | - Collin F Mulcahy
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, George Washington University Hospital, Washington, DC 20037, United States
| | - Stephanie Barak
- Department of Pathology, George Washington University Hospital, Washington, DC 20037, United States
| | - Muhammed F Shand
- George Washington University School of Medicine and Health Sciences, Washington, DC 20037, United States
| | - Christopher D Badger
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, George Washington University Hospital, Washington, DC 20037, United States
| | - Arjun S Joshi
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, George Washington University Hospital, Washington, DC 20037, United States
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8
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Synovial sarcoma of submandibular gland with aberrant P63 expression a case report of rare event. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.200314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Bouloux GF, Roser SM, Abramowicz S. Pediatric Tumors of the Temporomandibular Joint. Oral Maxillofac Surg Clin North Am 2018; 30:61-70. [PMID: 29153238 DOI: 10.1016/j.coms.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The incidence of tumors and pseudotumors of the temporomandibular joint (TMJ) in the pediatric population is low. They are often challenging to recognize unless associated with signs and symptoms that may erroneously be interpreted as TMJ dysfunction. Tumors of the TMJ can be divided into 3 categories based on the nature and type of precursor cell involved in the tumor: benign tumors, malignant tumors, and pseudotumors. This article discusses the most common entities in these categories.
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Affiliation(s)
- Gary F Bouloux
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Steven M Roser
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA; Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA; Section of Dentistry/Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA.
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10
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Vig T, Thomas M, Pai R, Tirkey A, Janakiraman R. Primary Synovial Sarcoma arising from gingivo-buccal sulcus harbouring SS18-SSX2 positive fusion transcript: The 1st reported case in English literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:220-223. [DOI: 10.1016/j.jormas.2017.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/12/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
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11
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Mallen-St Clair J, Arshi A, Abemayor E, St John M. Factors Associated With Survival in Patients With Synovial Cell Sarcoma of the Head and Neck: An Analysis of 167 Cases Using the SEER (Surveillance, Epidemiology, and End Results) Database. JAMA Otolaryngol Head Neck Surg 2017; 142:576-83. [PMID: 27100936 DOI: 10.1001/jamaoto.2016.0384] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Synovial cell sarcoma of the head and neck (SCSHN) is a rare tumor associated with significant morbidity and mortality. The literature regarding these tumors is limited to case series and case reports. We used data from the population-based US Surveillance, Epidemiology, and End Results (SEER) cancer registry to determine factors affecting both overall survival and disease-specific survival of patients with SCSHN. OBJECTIVE To determine the clinicopathologic and therapeutic factors determining survival in patients with SCSHN. DESIGN, SETTING, AND PARTICIPANTS The SEER registry was reviewed for patients with primary SCSHN from January 1, 1973, to January 1, 2011. MAIN OUTCOMES AND MEASURES Overall survival (OS) and disease-specific survival. RESULTS A total of 167 cases of SCSHN were identified. The mean (SD) age at diagnosis was 37.9 (17.3) years, and 100 (59.9%) of the patients were males. The monophasic spindle cell and biphasic variants were the most common histologic subtypes. Surgical resection and radiotherapy were performed in 150 (89.8%) and 108 (64.7%) of the cases, respectively. The median OS at 2, 5, and 10 years was 77%, 66%, and 53%, respectively. Univariate Kaplan-Meier survival analysis revealed that age, race, and tumor stage and size were associated with improved survival. Histologic subtype was not associated with significant differences in survival. Radiotherapy was associated with improved disease-specific survival (hazard ratio [HR], 0.29 [95% CI, 0.12-0.68]; P = .003), but surgical management was not associated with improved survival (HR, 0.52 [95% CI, 0.19-1.46]; P = .21). Multivariate Cox regression analysis revealed that size greater than 5 cm (adjusted HR, 3.60 [95% CI, 1.43-9.08]; P = .007) and stage at presentation (adjusted HR, 3.86 [95% CI, 2.01-7.44]; P < .001) were independent determinants of OS. In separate analysis of cohorts with tumors 5 cm or less and larger than 5 cm, stage at presentation was found to be a significant indicator of the probability of survival in both cohorts (adjusted HR, 3.10 [95% CI, 1.46-6.60]; P = .003 and 5.32 [95% CI, 1.49-18.98]; P = .01, respectively); surgical resection and radiotherapy were not associated with differential survival outcomes using this model. CONCLUSIONS AND RELEVANCE Synovial cell sarcoma of the head and neck is rare. Independent significant determinants of survival include size (>5 cm) and stage at presentation. Histologic subtype of the tumor is not a significant indicator of the probability of survival. Surgical resection and radiotherapy were not independent determinants of survival.
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Affiliation(s)
- Jon Mallen-St Clair
- Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles)2UCLA Head and Neck Cancer Program, David Geffen School of Medicine, UCLA
| | - Armin Arshi
- Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles)
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles)2UCLA Head and Neck Cancer Program, David Geffen School of Medicine, UCLA
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles)2UCLA Head and Neck Cancer Program, David Geffen School of Medicine, UCLA3Jonsson Comprehensive Cancer Center, David Geffen School of Medicin
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12
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Detection of Rare Variant of SS18-SSX1 Fusion Gene and Mutations of Important Cancer-Related Genes in Synovial Sarcoma of the Lip: Gene Analyses of a Case and Literature Review. J Oral Maxillofac Surg 2015; 73:1505-15. [PMID: 25959879 DOI: 10.1016/j.joms.2015.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 02/07/2023]
Abstract
Synovial sarcoma (SS) accounts for 5 to 10% of soft tissue sarcomas; however, intraoral SS is rare. Histopathologically, SS shows a biphasic pattern with epithelial and spindle cell components or a monophasic pattern with only spindle cells. The precise diagnosis of SS, especially at an unusual site, is often a challenge to pathologists and clinical oncologists, because the differential diagnosis of SS includes a broad range of tumors, such as soft tissue sarcomas and carcinomas. In the present case, the patient was a 50-year-old woman who presented with the chief complaint of swelling and a slowly enlarging mass of the lower lip in the mucolabial fold region. The mass was covered with intact mucosa and intraoral examination showed no malignant findings. The clinical diagnosis was a benign tumor and a probable salivary gland tumor. Macroscopically, the excised mass also indicated a benign tumor; however, histopathologic findings suggested the diagnosis of SS. For definitive diagnosis, genetic analyses were performed with conventional polymerase chain reaction and next-generation sequencing. As a result, a rare variant of the SS18-SSX1 fusion transcript, which could not be identified by routine procedures for genetic diagnosis, was detected. In addition, 8 missense mutations of cancer-related genes were confirmed. Detection of the fusion transcript is widely used in the diagnosis of SS; however, reported cases of transcript variants of each fusion gene type are limited. Reports of mutational analysis of cancer-related genes on SS also are rare. The accumulation of rare transcript variants and the cytogenetic characters of SS are suggested to be necessary for assuming a genetic diagnosis of SS.
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Wushou A, Miao XC. Tumor size predicts prognosis of head and neck synovial cell sarcoma. Oncol Lett 2014; 9:381-386. [PMID: 25435996 PMCID: PMC4247063 DOI: 10.3892/ol.2014.2634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 09/26/2014] [Indexed: 12/20/2022] Open
Abstract
Head and neck synoviosarcoma (HNSS) is uncommon. To the best of our knowledge, the specific clinicopathological characteristics, treatment outcome and prognostic factors of HNSS were uninvestigated at the time of writing, so a meta-analysis was performed. An online data collection was carried out using PubMed and Google Scholar. Studies that reported primary HNSS and the treatment, follow-up time and outcome were chosen for the present study. In total, 93 cases from 26 studies were included for analysis. The study sample consisted of 55 males and 38 females and the median age was 32.1 years (range, 4-76 years). The median follow-up period was 62.1 months (range, 1-373 months). The tumor size was correlated with local recurrence and metastasis of HNSS, as well as with mortality (P=0.001, P<0.0001 and P<0.0001, respectively). The three-year, five-year and 10-year survival rates were 82.1, 80.4 and 78.2% for treatment with surgery alone, and 88.5, 85.5 and 82% for treatment with surgery plus radiotherapy, respectively. A significant tumor size-dependent difference was found between the overall survival (OS) rates (P<0.0001), as tumors that were >5.0 cm in diameter were associated with a worse OS rate (hazard ratio, 6.460; 95% confidence interval, 206-18.917; P=0.001). The tumor size was found to be an independent adverse prognostic factor for the OS of HNSS patients. In conclusion, surgical excision is a mainstream treatment of HNSS and post-operative adjuvant radiotherapy improves the OS rate of HNSS patients.
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Affiliation(s)
- Alimujiang Wushou
- Cancer Research Institute, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xin-Chao Miao
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
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Manuguerra R, Bianchi B, Ferri A, De Filippo M, Lanfranco D, Sukov WR, Silini EM, Corradi D. Exclusive periductal/pericystic growth pattern in a case of long-standing monophasic synovial sarcoma of the parotid gland. Histopathology 2014; 67:130-3. [PMID: 25296532 DOI: 10.1111/his.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Roberta Manuguerra
- Unit of Pathology, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Unit of Maxillo-Facial Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
| | - Andrea Ferri
- Unit of Maxillo-Facial Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
| | - Massimo De Filippo
- Unit of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy
| | - Davide Lanfranco
- Unit of Maxillo-Facial Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Enrico Maria Silini
- Unit of Pathology, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
| | - Domenico Corradi
- Unit of Pathology, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy
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15
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Wushou A, Zhao YJ, Shao ZM. Synovial sarcoma of the infratemporal fossa: A case report. Oncol Lett 2014; 8:2165-2170. [PMID: 25295104 PMCID: PMC4186634 DOI: 10.3892/ol.2014.2436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/15/2014] [Indexed: 02/07/2023] Open
Abstract
Synovial sarcomas (SS) are high-grade soft-tissue sarcomas, predominantly found in the deep soft tissues of the lower extremities, with only 3-5% occurring in the head and neck region. Primary SS of the infratemporal fossa (ITF) is exceptionally uncommon. The present study reports the case of a 23-year-old female with an SS arising in the ITF. To the best of our knowledge, this case is only the second patient with intracranial involvement recorded in the literature. The patient was treated primarily with surgery, followed by a total of 60 Gy adjuvant radiotherapy and chemotherapy, consisting of cisplatin (25 mg/m2 intravenously on days one to three), epirubicin (25 mg/m2 intravenously on days one and two) and ifosfamide (1.8 g/m2 intravenously on days one to five) for three cycles. At present, two years after this multimodal therapy, the patient exhibits no signs of loco-regional recurrence or distant metastases. This study highlights the importance of a multidisciplinary approach in the diagnosis and treatment of this extremely rare entity with intracranial extension. In addition, the study reviews the English literature with regard to SS of ITF and discusses the clinicopathological features, management and outcome.
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Affiliation(s)
- Alimujiang Wushou
- Department of Oncology, Cancer Research Institute, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China ; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, P.R. China
| | - Ya-Jun Zhao
- Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhi-Ming Shao
- Department of Oncology, Cancer Research Institute, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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16
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Rao GV, Sravya T, Sivaranjani Y, Bhat VR. Primary biphasic synovial sarcoma of gingiva: Report of a rare case. J Oral Maxillofac Pathol 2014; 18:77-80. [PMID: 24959041 PMCID: PMC4065452 DOI: 10.4103/0973-029x.131916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Synovial sarcoma is a mesenchymal spindle cell tumor with variable epithelial differentiation. It is unrelated to the synovium as the name might suggest but arises in the soft tissues of the extremities around the knee joints and tendon sheaths. The tumor cells are thought to resemble normal synovial tissue histopathologically, hence named “synovial sarcoma” (SS). Head and neck lesions are less common and oral cavity involvement is extremely rare. Few cases in tongue, soft palate, mandible, buccal mucosa and floor of mouth have been described in the literature. Here, we probably report the first case of primary biphasic SS (BSS) involving gingiva in the retromolar area of the mandible in a 21-year-old male patient.
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Affiliation(s)
- Guttikonda Venkateswara Rao
- Department of Oral Pathology and Microbiology, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh, India
| | - Taneeru Sravya
- Department of Oral Pathology and Microbiology, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh, India
| | - Yeluri Sivaranjani
- Department of Oral Pathology and Microbiology, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh, India
| | - Vidya Rani Bhat
- Department of Oral Pathology and Microbiology, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh, India
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17
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Babu R.S. A, Reddy B.V. R, C.H. A. Histogenetic concepts, terminology and categorization of biphasic tumours of the oral and maxillofacial region. J Clin Diagn Res 2014; 8:266-70. [PMID: 24701553 PMCID: PMC3972583 DOI: 10.7860/jcdr/2014/7506.4078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/09/2013] [Indexed: 12/18/2022]
Abstract
A biphasic tumour is a truly histological term that refers to neoplastic tissue which is characterized by two different cellular elements. Several histogenetic theories have been proposed for the aetiogenesis of the biphasic tumours. Literatures have been published on the individual lesions, which have described their biphasic nature but, biphasic tumours have not been categorized singly . Categorizing biphasic tumours is not likely to highlight diagnostic standards, but it may sensitize the therapeutic planning and post operative monitoring. This review article focuses on the histogenetic concepts of biphasic tumours, and the histopathological description of the lesions that are suggested to be biphasic tumours.
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Affiliation(s)
- Arvind Babu R.S.
- Oral and Maxillofacial Pathologist and Microbiologist, Lecturer and Research Coordinator, Faculty of Medical Sciences – Dentistry Programme, The University of the West Indies, Mona, Kingston 7, Jamaica, West Indies
| | - Ramana Reddy B.V.
- Professor and Head, Department of the Oral Pathology and Microbiology,SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Anuradha C.H.
- Reader, Department of Oral Pathology and Microbiology,Sree Sai Dental College and Research Institute, Chapuram, Srikakulam, Andhra Pradesh, India
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18
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Cockerill CC, Daram S, El-Naggar AK, Hanna EY, Weber RS, Kupferman ME. Primary sarcomas of the salivary glands: case series and literature review. Head Neck 2013; 35:1551-7. [PMID: 23728801 DOI: 10.1002/hed.23203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mesenchymal malignancies of salivary origin are rare and are histologically diverse. We reviewed our experience with these tumors, as well as the published literature, with an emphasis on treatment modalities and prognosis. METHODS We identified 17 patients treated for malignant mesenchymal cell tumors at The University of Texas MD Anderson Cancer Center between 1990 and 2007. We compared our results to the literature from January 1990 to July 2010. RESULTS Tumors were located primarily in the parotid gland and were primarily T1 tumors (<5 cm). All patients were treated with surgical resection, and 13 patients were given adjuvant therapy. Seven patients (41%) had recurrence, and 4 developed distant metastases. The overall 5-year and 10-year survival rates were 42% and 20%, respectively. CONCLUSIONS Our case series and literature review show that sarcomas of the salivary glands have a high rate of recurrence and are associated with a poor prognosis.
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Affiliation(s)
- Cara C Cockerill
- The University of Texas Medical School at Houston, Houston, Texas
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20
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Synovial sarcomas of the head and neck: Comparative analysis with synovial sarcoma of the extremities. Auris Nasus Larynx 2013; 40:476-80. [DOI: 10.1016/j.anl.2012.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
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21
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Ngwenya SP, Bunn BK. Clinical pathologic conference case 1: Lesion presenting as a hemorrhagic mass of the alveolar ridge. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e59-63. [PMID: 23926612 DOI: 10.1016/j.oooo.2013.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S P Ngwenya
- University of Limpopo, University of Pretoria
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22
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Wadhwan V, Malik S, Bhola N, Chaudhary M. Biphasic synovial sarcoma in mandibular region. J Oral Maxillofac Pathol 2013; 15:239-43. [PMID: 22529590 PMCID: PMC3329687 DOI: 10.4103/0973-029x.84514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The term synovioma was coined by Smith in 1927, and later in 1936 Knox suggested the name synovial sarcoma. It occurs primarily in the paraarticular regions, usually in close association with tendon sheaths, bursae, and joint capsules. On rare occasions it may be seen in areas without any apparent relationship to synovial structures as in parapharyngeal region or the abdominal cavity. The first description of synovial sarcoma in the head and neck region was by Pack and Ariel in 1950. The majority of these tumors seem to take origin from paravertebral connective tissue spaces and manifest as solitary retropharyngeal or parapharyngeal masses near the carotid bifurcation. Synovial sarcoma has been reported in soft palate, tongue, maxillofacial region, angle of mandible, sternoclavicular region, scapular region, and the esophagus. We report a case of 28-year-old male patient with synovial sarcoma in mandibular region with biphasic pattern.
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Affiliation(s)
- Vijay Wadhwan
- Department of Oral Pathology, ITS Dental College, Ghaziabad, Uttar Pradesh, India
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23
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Synovial Sarcoma of the Infratemporal Fossa With Extension Into the Oral Cavity—A Rare Presentation and Literature Review. J Oral Maxillofac Surg 2012; 70:2923-9. [DOI: 10.1016/j.joms.2012.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 01/14/2023]
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24
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Mariano FV, Oliveira Gondak R, da Costa MV, Corrêa MB, Lopes MA, de Almeida OP. Primary synovial sarcoma involving the submandibular gland. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e61-5. [PMID: 22727109 DOI: 10.1016/j.oooo.2011.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/21/2011] [Accepted: 12/11/2011] [Indexed: 11/26/2022]
Abstract
Synovial sarcoma represents 5.6%-10% of all soft-tissue sarcomas. Adolescents and young adults are most frequently affected, mainly in the deep soft tissue of the extremities. Only 10% of synovial sarcomas affect the head and neck region; most of these are biphasic. We describe a case of an 18-year-old man who complained of a mass in the right submandibular region that had been present for approximately 12 months. On surgical removal, microscopic analysis showed a tumor formed by sheets of malignant spindle cells involving the submandibular gland. Immunohistochemistry displayed positivity for AE1/AE3, CK18/8, epithelial membrane antigen, CD99, CD56, and TLE-1. Based on these immunohistochemical and histopathologic features, a diagnosis of monophasic synovial sarcoma was rendered. The patient was treated with adjuvant radiotherapy and after 1 year was free of disease. To the best of our knowledge, this is the first reported case of synovial sarcoma involving the submandibular gland.
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Affiliation(s)
- Fernanda Viviane Mariano
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
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Villaroel-Salinas J, Campos-Martinez J, Ortiz-Hidalgo C. Synovial Sarcoma of the Tongue Confirmed by Molecular Detection of the SYT-SSX2 Fusion Gene Transcript. Int J Surg Pathol 2011; 20:386-9. [DOI: 10.1177/1066896911424897] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Involvement of the tongue by a synovial sarcoma (SS) is an extremely rare event; there have only been 13 cases previously reported. The authors present herein a case of monophasic SS arising in the tongue in a 32-year-old woman. The neoplasm expressed cytokeratins AE1-3, OSCAR, and EMA as well as Bcl-2 and TLE1. Molecular analysis indicated that the patient tested positive for the SYT/SS2 fusion transcript.
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Affiliation(s)
| | | | - Carlos Ortiz-Hidalgo
- The American British Cowdray Medical Centre, Mexico City, Mexico
- Universidad Panamericana, México City, Mexico
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26
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Lukšić I, Virag M, Manojlović S, Obradović B, Macan D, Stepan J. Primary synovial sarcoma of the parotid gland in 15-year-old boy. J Craniomaxillofac Surg 2011; 39:445-8. [DOI: 10.1016/j.jcms.2010.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 01/11/2010] [Accepted: 10/04/2010] [Indexed: 11/25/2022] Open
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Ji T, Ma CY, Ow A, Wang LZ, Sun J, Zhang CP. Synovial sarcoma involving skull base--a retrospective analysis of diagnosis and treatment of 21 cases in one institution. Oral Oncol 2011; 47:671-6. [PMID: 21641853 DOI: 10.1016/j.oraloncology.2011.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
To retrospectively review the diagnosis and treatment outcomes of 21 diagnosed with synovial sarcoma (SS) extending to skull base region and identify prognostic factors for local recurrence and distant metastasis. The clinical and pathological records of 21 synovial sarcoma cases involving skull base treated at Department of Oral and Maxillofacial Surgery, Affiliated to Ninth People's Hospital, Shanghai Jiao Tong University, from 2003 to 2008 were reviewed. Parameters including clinical, radiographic, histological findings, and treatment modalities were analyzed. Prognostic factors influencing overall survival, local recurrence, and metastasis were identified. Categorical variables were compared between groups for local recurrence and distant metastasis by using 2-tailed Fisher exact test. The sample consisted of 8 males and 13 females with a median age of 23. 42.9% of cases showed skull base bone erosion with 9.5% of cases presenting intracranial tumor extension. 52.4% of cases died from recurrence or metastasis with a median survival time of 11 months. Orbital involvement, perineural and cranial invasion along with other factors were statistically significant for their impact on overall survival. Local recurrence was associated with tumors located in the infratemporal space (p=0.01), perineural invasion (p=0.001), pathological grade 3 (p=0.005), and tumor size >5 cm (p=0.008). The aggressive behavior of skull base SS and its close proximity to vital structures make the diagnosis and management a challenge. The study reported high local recurrence rates despite surgical and postoperative radiotherapy. Adjuvant chemotherapy did not seem to affect distant metastasis rates.
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Affiliation(s)
- Tong Ji
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, PR China.
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Diagnosis and treatment of primary synovial cell sarcoma that occurred in the left mandible body: a case report and literature review. ACTA ACUST UNITED AC 2010; 111:e12-20. [PMID: 21169037 DOI: 10.1016/j.tripleo.2010.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/10/2010] [Accepted: 08/10/2010] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The authors describe a case of synovial sarcoma in the left mandible body. STUDY DESIGN The primary tumor was investigated morphologically and immunohistochemically. The patient was treated with madibulectomy and lymph node dissection, which was followed by an immediate reconstruction of the left mandible with a revascularized osteomyocutaneous fibula free flap. RESULTS The primary tumor was described as gingival sarcoma. The initial preoperative biopsy showed positive staining for cytokeratin, vimentin, smooth muscle actin, and desmin by immunohistochemistry. The definitive diagnosis of monophasic synovial sarcoma was established following postoperative excision biopsy. Antigens of S-100 and CD99 displayed positive staining but epithelial membrane antigen, Bcl-2, and CD34 were negative. Also, no metastasis or other bone swelling was observed by radionuclide survey suggesting the left mandible was the primary lesion of occurrence. CONCLUSIONS Synovial sarcoma is an uncommon soft tissue malignant neoplasm. This is the sixth case of primary synovial sarcoma occurring in the jaw.
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de Almeida-Lawall M, Mosqueda-Taylor A, Bologna-Molina RE, Domínguez-Malagón HR, Cano-Valdéz AM, Luna-Ortiz K, da Cunha IW. Synovial sarcoma of the tongue: case report and review of the literature. J Oral Maxillofac Surg 2009; 67:914-20. [PMID: 19304058 DOI: 10.1016/j.joms.2008.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 07/23/2008] [Accepted: 08/29/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Melaine de Almeida-Lawall
- PhD Student, Department of Oral Pathology, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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