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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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Teixeira LN, da Cruz EZ, Rosa ACG, Rodrigues AA, Passador-Santos F, de Araújo VC, Soares AB. Primary Intraosseous Synovial Sarcoma in the Mandible. Case Rep Oncol Med 2021; 2021:9945591. [PMID: 34877023 PMCID: PMC8645409 DOI: 10.1155/2021/9945591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
Synovial sarcoma (SS) is a rare malignant mesenchymal tumor that mainly occurs in body extremities, being uncommon in the head and neck region. In the present study, we described a case of primary intraosseous SS arising in the mandible of a 22-year-old young male. The patient reported a painful swelling on the left side of the mandible for the last 7 months. Imaging exams showed the presence of an expansive and multilocular radiolucent lesion, extending from the left condyle to the mandibular body. The clinic diagnostic hypotheses were ameloblastoma or malignant neoplasm. Histologically, the lesion was characterized by a proliferation of spindle cells exhibiting vesicular nuclei and evident nucleolus. Neoplastic cells were positive for AE1/AE3, cytokeratin 7, vimentin, CD-99, and TLE-1 and negative for CD-34, S-100, SMA, and HHF-35. A combination of clinical, histologic, and immunohistochemical characteristics supported the diagnosis of SS. The patient was referred for treatment, and preoperative exams did not reveal any other tumor foci in the body of the patient. The final diagnosis was of a primary intraosseous SS of the mandible.
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Affiliation(s)
- Lucas Novaes Teixeira
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | - Eduardo Zambaldi da Cruz
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | - Ana Cláudia Garcia Rosa
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
- School of Medicine, Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/n-Plano Diretor Norte, Palmas TO 77001-090, Brazil
| | - Anderson Abdo Rodrigues
- School of Medicine, Federal University of Tocantins, Avenida NS-15, Quadra 109, Norte, S/n-Plano Diretor Norte, Palmas TO 77001-090, Brazil
| | - Fabrício Passador-Santos
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
| | | | - Andresa Borges Soares
- Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira 13, Swift, 13045-755 Campinas, SP, Brazil
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Reichel CA. Rare Diseases of the Oral Cavity, Neck, and Pharynx. Laryngorhinootologie 2021; 100:S1-S24. [PMID: 34352905 PMCID: PMC8432966 DOI: 10.1055/a-1331-2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diseases occurring with an incidence of less than 1-10 cases per 10 000 individuals are considered as rare. Currently, between 5 000 and 8 000 rare or orphan diseases are known, every year about 250 rare diseases are newly described. Many of those pathologies concern the head and neck area. In many cases, a long time is required to diagnose an orphan disease. The lives of patients who are affected by those diseases are often determined by medical consultations and inpatient stays. Most orphan diseases are of genetic origin and cannot be cured despite medical progress. However, during the last years, the perception of and the knowledge about rare diseases has increased also due to the fact that publicly available databases have been created and self-help groups have been established which foster the autonomy of affected people. Only recently, innovative technical progress in the field of biogenetics allows individually characterizing the genetic origin of rare diseases in single patients. Based on this, it should be possible in the near future to elaborate tailored treatment concepts for patients suffering from rare diseases in the sense of translational and personalized medicine. This article deals with orphan diseases of the lip, oral cavity, pharynx, and cervical soft tissues depicting these developments. The readers will be provided with a compact overview about selected diseases of these anatomical regions. References to further information for medical staff and affected patients support deeper knowledge and lead to the current state of knowledge in this highly dynamic field.
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Affiliation(s)
- Christoph A Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, KUM-Klinikum, Ludwig-Maximilians-Universität München, München
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Alabdulaaly L, AlDawood Z, Afshar S, Rahbar R, Al-Ibraheemi A, Woo SB. Calcifying synovial sarcoma of the tongue with SS18 rearrangement: a rare variant in a rare location. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 132:e186-e189. [PMID: 32981875 DOI: 10.1016/j.oooo.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
Synovial sarcoma is a soft tissue malignancy harboring t(X;18) resulting in fusion of two genes SS8 (at 18q11) and SSX (1, 2 or 4 at Xp11) forming the gene fusion product SS18-SSX. It affects adults in their 3rd-4th decades, most frequently in the para-articular regions of the extremities. Less than 10% of the cases occur within the head and neck region and of these, 60% occur in the neck and only 10% occur in the oral cavity. We report a synovial sarcoma of the tongue in a 14-year-old female patient with unusual histology. The patient presented with a mass occupying most of the tongue with extension into the floor of mouth and the lingual gingiva of the anterior mandibular teeth. The tumor was composed of a highly cellular proliferation of spindle cells in a herringbone pattern with many small vessels but without glandular structures, and with extensive calcifications throughout the tumor. Tumor cells were positive for epithelial membrane antigen and transducin-like enhancer of split-1, and fluorescence in situ hybridization studies identified SS18 gene rearrangement. The patient was managed with two debulking procedures followed by chemoradiation and is currently alive with disease.
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Affiliation(s)
- Lama Alabdulaaly
- Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Zahra AlDawood
- Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Salim Afshar
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | | | - Sook-Bin Woo
- Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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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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Sharma V, Mehan R. Monophasic Synovial Sarcoma of Tongue: A Rarest of Rare Case Scenario. Indian J Otolaryngol Head Neck Surg 2018; 71:585-588. [PMID: 31742025 DOI: 10.1007/s12070-018-1418-0] [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] [Received: 11/14/2017] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
Synovial sarcoma is a rare tumour of head and neck. Primary synovial sarcoma of tongue is very uncommon. Based on morphology, it can be classified as classical biphasic variant, monophasic spindle cell variant, monophasic epithelial variant and poorly differentiated variant. The authors with an index case of 74 year old lady with monophasic spindle cell synovial sarcoma of oral tongue which is one of the rarest variants (our case is the 15th case reported of synovial sarcoma of the tongue and only the 3rd case in the world which had a monophasic histopathologic pattern) studied the morphology and described the disease entity in detail. She was treated with wide local excision of sarcoma followed by adjuvant radiotherapy.
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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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Liu Z, Jin S, Fu S, Hu Y, He Y. Management of the Primary Intraosseous Synovial Sarcoma of the Jaws: Be Careful of the Surgical Margin. J Oral Maxillofac Surg 2015; 73:550-63. [DOI: 10.1016/j.joms.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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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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Crowson MG, Lalich I, Keeney MG, Garcia JJ, Price DL. Clinicopathologic factors and adjuvant treatment effects on survival in adult head and neck synovial cell sarcoma. Head Neck 2014; 37:375-80. [DOI: 10.1002/hed.23605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/02/2013] [Accepted: 01/08/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Ian Lalich
- Department of Otorhinolaryngology - Head and Neck Surgery; The Mayo Clinic; Rochester Minnesota
| | - Michael G. Keeney
- Department of Laboratory Medicine and Pathology; The Mayo Clinic; Rochester Minnesota
| | - Joaquin J. Garcia
- Department of Laboratory Medicine and Pathology; The Mayo Clinic; Rochester Minnesota
| | - Daniel L. Price
- Department of Otorhinolaryngology - Head and Neck Surgery; The Mayo Clinic; Rochester Minnesota
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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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13
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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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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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Jimenez AL, Salvo NL. Mycetoma or synovial sarcoma? A case report with review of the literature. J Foot Ankle Surg 2011; 50:569-76. [PMID: 21616683 DOI: 10.1053/j.jfas.2011.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Indexed: 02/03/2023]
Abstract
Mycetoma, also commonly referred to as Madura foot, is statistically rare in the United States. However, it is endemic to other parts of the world. It is a pseudotumor characterized by a triad of tumefaction, draining sinuses, and grains. Two types exist, with each caused by different groups of organisms that require different treatment approaches. Therefore, the exact diagnosis and culture of the organism is vital to successful treatment outcomes. Synovial sarcoma, in contrast, is a malignancy much more commonly seen in the United States. It is characterized by a well-circumscribed, often palpable, mass that is usually well delineated on magnetic resonance imaging. It has characteristic histologic and genetic features that help distinguish it from other soft tissue masses. We present a case of a soft tissue mass diagnosed in the United States. The patient had several clinical and radiographic features of synovial sarcoma but the histologic outcome was mycetoma. The case is followed by a review of the published data.
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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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