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Patel RR, Delclos GL, DeSantis SM, Cannell MB, Lupo PJ, Lin PP, Araujo DM. Epidemiological trends of synovial sarcoma by primary tumor sites in the US from 2000 to 2020. Cancer Epidemiol 2024:102627. [PMID: 39048411 DOI: 10.1016/j.canep.2024.102627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Synovial sarcoma (SS) is a rare soft-tissue cancer. Existing literature encompasses Surveillance, Epidemiology, and End Results (SEER) data-based research on SS explaining the incidence-prevalence in general, by subtypes, and by age at diagnosis. Therefore, this study aimed to fill in the gap of knowledge about measures of disease occurrence and burden of SS by tumor site using the SEER database. METHODS In this cross-sectional study, primary SS patients were selected from SEER 17 Registries, Nov. 2021 (2000-2020) using ICD-O-3 codes 9040, 9041, 9042, and 9043. Patients with additional cancers were excluded. The primary tumor site was categorized into (1) head/neck, (2) internal thorax, (3) abdomen/pelvis, (4) upper extremity, and (5) lower extremity using ICD-10CM codes. Five outcomes were analyzed: age-adjusted incidence rate, 5-year limited-duration prevalence rate, incidence-based mortality, case-fatality rate, and overall survival. RESULTS From 2000-2020, the overall age-adjusted incidence rate was 0.15 per 100,000; the 5-year limited duration prevalence rate was 0.56 per 100,000; and the incidence-based mortality rate was 0.06 per 100,000 people. The case-fatality and 5-year OS rates were 39.2 % and 62.9 %, respectively. Lower extremity had the highest incidence of 0.07 (estimated 1166 cases), prevalence of 0.36 (estimated 224 cases), and mortality rate of 0.025 (estimated 429 deaths) per 100,000. The other four locations had much closer rates with each other. Intrathoracic SS had the highest case-fatality rate of 71.5 % (148/207) and lowest 5-year OS of 26.0 % (95 % CI: 19.6 %, 32.9 %) than other sites. CONCLUSION Based on the measures of disease frequency, the most common primary tumor site is the lower extremity, followed by the upper extremity, abdomen/pelvis, internal thorax, and head/neck. The least favorable primary location is the internal thorax. Those with a primary location of the upper extremity have the longest overall survival, followed by the head/neck, lower extremity, abdomen/pelvis, and internal thorax.
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Affiliation(s)
- Riddhi R Patel
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Epidemiology, The UTHealth Houston School of Public Health, TX, USA
| | - George L Delclos
- Department of Environmental and Occupational Health Sciences, The UTHealth Houston School of Public Health, TX, USA
| | - Stacia M DeSantis
- Department of Biostatistics, The UTHealth Houston School of Public Health, TX, USA
| | - Michael B Cannell
- Department of Epidemiology, The UTHealth Houston School of Public Health, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dejka M Araujo
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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2
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Mao M, Deng S. Lymph node myeloid sarcoma with TP53‑associated myelodysplastic syndrome: A case report. Oncol Lett 2024; 28:324. [PMID: 38807682 PMCID: PMC11130743 DOI: 10.3892/ol.2024.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/09/2024] [Indexed: 05/30/2024] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary tumor mass that carries a high risk of progression to acute myeloid leukemia (AML), and patients with MS are commonly treated with the AML regimen. However, MS is frequently misdiagnosed due to its lack of clinical specificity. Patients with MS who harbor tumor protein p53 (TP53) mutations and complex karyotypes are considered to have a poorer prognosis. The present study reports a case of lymph node MS with TP53 (V173G)-related myelodysplastic syndrome (MDS). The mass was first considered to be a lymphoma and treated as such. However, following immunohistochemical analysis, which revealed cells positive for CD43, myeloperoxidase and CD117, the patient was later diagnosed with MS combined with MDS. The patient went into complete remission after the first cycle of chemotherapy, and showed a decrease in platelet, red blood cell and white blood cell counts following the second cycle of chemotherapy. After the third chemotherapy, agranulocytosis occurred, leading to refractory pneumonia and eventually death due to respiratory failure. MS with TP53-related MDS has a low incidence rate, a poor prognosis and a short survival time. The clinical manifestations of MS are non-specific and easy to misdiagnose, leading to delayed diagnosis and treatment, and ultimately worsening the prognosis of the patients. Therefore, a lymph node biopsy should be performed as soon as possible for patients with lymph node enlargement, and early treatment should be carried out to prolong the survival period.
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Affiliation(s)
- Mengke Mao
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310006, P.R. China
| | - Shu Deng
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310006, P.R. China
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3
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Guo Y, Lin C, Li XX, Zhou JJ, Wang J. Synovial sarcoma in the prevertebral space can mimic malignant neurogenic neoplasm: Case report and literature review. Radiol Case Rep 2023; 18:4195-4201. [PMID: 37753502 PMCID: PMC10518339 DOI: 10.1016/j.radcr.2023.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Synovial sarcoma, a rare malignant neoplasm with a poor prognosis, accounts for approximately 5%-10% of all primary soft-tissue malignancies worldwide. Typically affecting adolescents and young adults, it primarily manifests near the joints of the lower extremities. This study aimed to demonstrate that this tumor can also affect the prevertebral space. A 32-year-old male patient presented at our outpatient clinic with a 2-month history of upper limb numbness and a 1-month complaint of palpable neck mass. Imaging studies revealed a bulky, lobulated, and heterogeneous mass exhibiting heterogeneous enhancement. Furthermore, the mass caused expansion of the neuroforamen in the neck, initially suggesting a diagnosis of malignant schwannoma. However, a histopathologic examination suggested synovial sarcoma. The article provided a comprehensive review of the clinical, pathological, and radiological features of this condition. Additionally, it explored current treatment options and prognoses by referencing relevant literature.
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Affiliation(s)
- Yi Guo
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian Province, China
| | - Chong Lin
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian Province, China
| | - Xiao-xia Li
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian Province, China
| | - Jian-jun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian Province, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Xiamen Municipal Clinical Research Center for Medical Imaging, Fujian Province, China
| | - Jian Wang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, Fujian Province, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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4
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Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel) 2023; 15:4860. [PMID: 37835554 PMCID: PMC10571652 DOI: 10.3390/cancers15194860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15-40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the "triple sign"), in addition to features like hemorrhage and fluid-fluid levels with septa (resulting in the "bowl of grapes" appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2-4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
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Affiliation(s)
- Eun Byul Cho
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yuri Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Sharma AE, Kerr DA, Cipriani NA. Small biopsies in the head and neck: Bone and soft tissue. Semin Diagn Pathol 2023; 40:353-370. [PMID: 37453847 DOI: 10.1053/j.semdp.2023.06.003] [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: 02/04/2023] [Revised: 04/30/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.
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Affiliation(s)
- Aarti E Sharma
- Hospital for Special Surgery, New York, NY, United States
| | - Darcy A Kerr
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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6
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Kim J, Johnson BR, Tamaki A, Lavertu P. A case report of uremic tumoral calcinosis in the head and neck and literature review of calcified lesions of the head and neck. Am J Otolaryngol 2023; 44:103862. [DOI: 10.1016/j.amjoto.2023.103862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
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7
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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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De Ravin E, Marrero Berrios JC, Rajasekaran K. Parotid Mass in an 81-Year-Old Woman. JAMA Otolaryngol Head Neck Surg 2022; 148:981-982. [PMID: 35951315 DOI: 10.1001/jamaoto.2022.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An 81-year-old woman presented with a 3-month history of a slow-growing mass in her left cheek and denied having any symptoms, tenderness, numbness, or facial nerve weakness. What is your diagnosis?
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia
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9
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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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10
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Patel RR, Lupo PJ, Bishop AJ, Lin PP, Delclos GL, Lazar AJ, Benjamin RS, Araujo DM. Synovial Sarcoma of the Hand and Foot: An Institutional Review. Am J Clin Oncol 2021; 44:361-368. [PMID: 33927134 DOI: 10.1097/coc.0000000000000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Synovial sarcomas (SS) arising in distal extremities are rare and have been studied using mostly case reports and small series. We aimed to evaluate clinical presentation and survival outcomes for patients with hand or foot SS. MATERIALS AND METHODS We conducted a retrospective review of 84 patients diagnosed with primary hand (n=20) and foot (n=64) SS between 1979 and 2019. Progression-free survival (PFS), overall survival (OS), local recurrence-free survival and metastasis-free survival were estimated using the Kaplan-Meier method and log-rank test. Cox-proportional hazards regression was used to estimate the hazard ratios. RESULTS Of 84 patients, 63 (75%) presented with localized disease with 36 years median age at diagnosis (range: 4 to 76) and 21 (25%) with metastasis with 30 years median age at diagnosis (range: 15 to 64). Among patients presenting with localized disease, (1) 5 years-PFS, OS, local recurrence-free survival, and metastasis-free survival rates were 82%, 88%, 100%, and 86%, respectively. (2) Tumor size <3.0 cm corresponded to 95% 5 years-PFS (vs. 84% for 3.0 to 4.9 cm, 53% for ≥5.0 cm; P=0.007) and 100% 5 years-OS (vs. 77% for ≥3.0 cm; P=0.04). (3) Patients with ≥5.0 cm (vs. <3.0 cm) tumor size had 7.99 (95% confidence interval: 1.68, 37.91) times higher hazard of progression. Remarkably, patients presenting with metastasis had 50% 5 years-OS rate. Also, younger age (15 to 39 vs. 40 y and above) predicted better OS among patients presenting with localized disease (P=0.04) and with metastasis (P=0.03). CONCLUSIONS Survival outcomes are favorable for younger patients with <3.0 cm hand or foot SS. Local control is excellent, but we observed larger tumor size to be associated with poorer outcomes. Therefore, we recommend consideration of systemic therapy for patients with ≥3.0 cm hand or foot SS.
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Affiliation(s)
- Riddhi R Patel
- Departments of Sarcoma Medical Oncology
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | | | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center
| | - Alexander J Lazar
- Pathology
- Genomic Medicine, The University of Texas MD Anderson Cancer Center
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Sapalidis K, Laskou S, Manaki V, Magra V, Pantea S, Gkeka T, Mogoantă CA, Pîrvu DC, Kesisoglou I. Neck synovial sarcoma: case presentation. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:575-579. [PMID: 35024747 PMCID: PMC8848270 DOI: 10.47162/rjme.62.2.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
Head and neck synovial sarcoma (HNSS) is a rare tumor with a few case reports or case series being published in the literature. We present the case of a 68-year-old patient admitted to our department for management of a palpable neck mass. After initial investigation and due to major problems of differential diagnosis, there was performed a wide excision of the tumor. Histopathology examination revealed an HNSS.
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Affiliation(s)
- Konstantinos Sapalidis
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stiliani Laskou
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Vasiliki Manaki
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Vasiliki Magra
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stelian Pantea
- Department of Surgery, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Theodora Gkeka
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Carmen Aurelia Mogoantă
- Department of ENT, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Daniel-Cristian Pîrvu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Isaak Kesisoglou
- 3 Department of Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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12
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Kyriazoglou A, Timmermans I, De Cock L, Laenen A, Dumez H, Sinnaeve F, Wafa H, Hompes D, Van Raemdonck D, De Leyn P, Sciot R, Hauben E, Debiec-Rychter M, Vandenbempt I, Schöffski P. Management of Synovial Sarcoma in a Tertiary Referral Center: A Retrospective Analysis of 134 Patients. Oncol Res Treat 2021; 44:232-241. [PMID: 33756486 DOI: 10.1159/000515112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Synovial sarcomas (SS) are malignant mesenchymal neoplasms that account for about 10% of all sarcomas. Complete surgical excision is the mainstay of primary treatment for localized disease, but SS have a high tendency for local relapse and metastases. Metastatic disease is commonly treated with systemic chemotherapy. METHODS We designed a retrospective analysis to describe the clinical presentation, course of treatment, outcome, and prognosis of patients with SS. Univariate and multivariate analyses were performed for potential prognostic factors. RESULTS We identified 134 patients treated between 1987 and 2018, with a cutoff date of December 2018. Demographics, disease characteristics, treatment, and survival rates were collected and analyzed. The median overall survival (mOS) from the date of diagnosis was 96.7 months. The median progression-free survival was 6.37 months. Disease-free survival was 26 months. Age over 65 years was found to be a prognostic factor with statistically significant value in the univariate analysis regarding mOS (p = 0.015) and mOS after local relapse (p = 0.0228). CONCLUSIONS Even though our study is limited by the retrospective nature of the analysis, it adds an important amount of clinical data regarding the treatment and outcome of SS.
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Affiliation(s)
| | - Iris Timmermans
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lore De Cock
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Biostatistics, Catholic University of Leuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Friedl Sinnaeve
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hazem Wafa
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Esther Hauben
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Patrick Schöffski
- Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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Synovial sarcoma of the head & neck: A review of reported cases in the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:505-510. [PMID: 33301946 DOI: 10.1016/j.jormas.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022]
Abstract
Synovial sarcoma is a high-grade malignancy that seldom manifests in the head and neck. The purpose of this paper is to provide a comprehensive review of the existing literature on primary HNSS. This review study includes case reports, case series and retrospective cohort studies on primary HNSS published in the English language. All cases identified via PubMed were analyzed individually. Articles were included according to specified eligibility criteria. The total number of cases analyzed was 243 (91 case reports, 53 cases from 16 case series, and 99 cases from 8 retrospective cohort studies). The average age at the time of HNSS diagnosis was 33.5 years. The ratio of male-to-female was 1.64:1. The most frequently occurring histologic subtype was biphasic (59.2%). The most common location was the neck. Hoarseness was the most common presenting symptom. Almost all patients (98.3%) underwent surgical excision. 55.6% of patients received adjuvant radiotherapy. A smaller number of patients (30.7%) received adjuvant chemotherapy. 60.3% of patients were alive with no evidence of disease at follow-up while 28.0% of patients died of HNSS at follow-up. The average follow-up period was 52.0 months. Synovial sarcoma is a rare head and neck malignancy. Surgical excision with adjuvant radiation is the most frequently employed treatment modality. Regardless of treatment modality, the prognosis of the tumor is guarded.
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14
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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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Almahdi M, ALRashed ALHumaid S, Alsafi M, AlObaid F, Alsalim A. Nasal spindle cell sarcoma: A case report. Int J Surg Case Rep 2020; 72:515-519. [PMID: 32698278 PMCID: PMC7322102 DOI: 10.1016/j.ijscr.2020.05.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Synovial sarcoma is a mesenchymal high grade tumor. It is found in soft tissue mostly lower extremities. It is rarely found in the head and neck area with paraspinal neck accounting for the most common location. In rare occasions, it can be found in nasal cavity. CASE PRESENTATION A 46-year-old female patient presented with recurrent epistaxis for 7 months. A 0-degree rigid scope examination revealed a left nasal cavity mass. A non-contrasted CT scan of the paranasal sinus showed heterogeneous and hypodense lesion in the left nasal cavity. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed high grade spindle cell sarcoma favoring synovial type. Further workup and management were done from MRI, cranial tumor resection with skull base reconstruction to adjuvant radiotherapy. Patient has regular follow up with involved specialties and thus far is doing well. CONCLUSION Spindle cell synovial sarcoma is a rare lesion found in soft tissue. It is unusual to be found in nasal cavity. Thus crucial attention to the clinical, radiographical and histopathological manifestation should be taken for more accurate diagnosis and further appropriate management.
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Affiliation(s)
- Mohammad Almahdi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Salwa ALRashed ALHumaid
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Maryam Alsafi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad AlObaid
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Alaa Alsalim
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital National Guard Health Affairs, Riyadh, Saudi Arabia
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Wang DJ, Alwafi L, Pritchett SL, Wehrli BM, Spouge ARI. The Imaging Spectrum of Synovial Sarcomas: A Pictorial Review From a Single-Centre Tertiary Referral Institution. Can Assoc Radiol J 2020; 72:470-482. [PMID: 32067487 DOI: 10.1177/0846537119899284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Synovial sarcomas are malignant soft-tissue tumors that typically affect young patients. They can arise from nearly anywhere in the body, most commonly the extremities, head and neck, and thorax. The imaging features are highly variable and depend on the anatomic origin. Most lesions present as large aggressive heterogeneous masses containing hemorrhagic and cystic foci, often with calcification. However, up to one-third of lesions have commonly benign features and can appear homogeneously solid or cystic. Especially in these cases, their innocuous imaging and clinical presentation can lead to delayed diagnosis. Therefore, knowledge of the imaging spectrum is crucial to ensuring adequate follow-up or timely pathologic sampling. We reviewed 30 pathologically proven cases in various anatomic sites from our institution to illustrate these characteristics.
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Affiliation(s)
- David Jueyu Wang
- Department of Medical Imaging, 10033London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Leena Alwafi
- Department of Medical Imaging, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Stephany Lynn Pritchett
- Department of Medical Imaging, 10033London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Bret Michael Wehrli
- Department of Pathology and Laboratory Medicine, 10033London Health Sciences Centre, University Hospital, London, Ontario, Canada
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17
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Halily S, Ballage A, Ardhaoui H, Rouadi S, Abada R, Roubal M, Mahtar M, El Khiraoui H, Belhaj S, Marnissi F. Synovial sarcoma of the supraclavicular region causing a hemorrhagic shock. Clin Case Rep 2019; 7:2054-2058. [PMID: 31788250 PMCID: PMC6878071 DOI: 10.1002/ccr3.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/09/2022] Open
Abstract
A cystic mass that rapidly increases in volume in a dangerous anatomical region, notably the supraclavicular region, which contains important neurovascular elements, must be considered at high risk. A vascular study is mandatory before biopsy. Neoadjuvant chemotherapy can be a treatment option in high-risk synovial sarcoma.
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Affiliation(s)
- Sara Halily
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Amine Ballage
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Hamida Ardhaoui
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Sami Rouadi
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Redallah Abada
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Mohamed Roubal
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Mohamed Mahtar
- Otorhinolaryngology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | | | - Salwa Belhaj
- Pathology DepartmentCasablanca Teaching HospitalCasablancaMorocco
| | - Farida Marnissi
- Pathology DepartmentCasablanca Teaching HospitalCasablancaMorocco
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18
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Thoenen E, Curl A, Iwakuma T. TP53 in bone and soft tissue sarcomas. Pharmacol Ther 2019; 202:149-164. [PMID: 31276706 DOI: 10.1016/j.pharmthera.2019.06.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Genomic and functional study of existing and emerging sarcoma targets, such as fusion proteins, chromosomal aberrations, reduced tumor suppressor activity, and oncogenic drivers, is broadening our understanding of sarcomagenesis. Among these mechanisms, the tumor suppressor p53 (TP53) plays significant roles in the suppression of bone and soft tissue sarcoma progression. Although mutations in TP53 were thought to be relatively low in sarcomas, modern techniques including whole-genome sequencing have recently illuminated unappreciated alterations in TP53 in osteosarcoma. In addition, oncogenic gain-of-function activities of missense mutant p53 (mutp53) have been reported in sarcomas. Moreover, new targeting strategies for TP53 have been discovered: restoration of wild-type p53 (wtp53) activity through inhibition of TP53 negative regulators, reactivation of the wtp53 activity from mutp53, depletion of mutp53, and targeting of vulnerabilities in cells with TP53 deletions or mutations. These discoveries enable development of novel therapeutic strategies for therapy-resistant sarcomas. We have outlined nine bone and soft tissue sarcomas for which TP53 plays a crucial tumor suppressive role. These include osteosarcoma, Ewing sarcoma, chondrosarcoma, rhabdomyosarcoma (RMS), leiomyosarcoma (LMS), synovial sarcoma, liposarcoma (LPS), angiosarcoma, and undifferentiated pleomorphic sarcoma (UPS).
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Affiliation(s)
- Elizabeth Thoenen
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66010, USA
| | - Amanda Curl
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS 66010, USA
| | - Tomoo Iwakuma
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66010, USA; Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS 66010, USA; Translational Laboratory Oncology Research, Children's Mercy Research Institute, Kansas City, MO 64108, USA.
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Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification. AJR Am J Roentgenol 2018; 212:644-654. [PMID: 30589383 DOI: 10.2214/ajr.18.19894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas. CONCLUSION An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.
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20
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Synovial sarcomas of the upper aero-digestive tract: is there a role for conservative surgery? Curr Opin Otolaryngol Head Neck Surg 2018; 26:94-101. [DOI: 10.1097/moo.0000000000000440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Saito S, Ozawa H, Ikari Y, Nakahara N, Ito F, Sekimizu M, Fukada J, Kameyama K, Ogawa K. Synovial sarcoma of the maxillary sinus: an extremely rare case with excellent response to chemotherapy. Onco Targets Ther 2018; 11:483-488. [PMID: 29416348 PMCID: PMC5789048 DOI: 10.2147/ott.s151473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This paper presents an extremely rare case of synovial sarcoma arising from the maxillary sinus, which resulted in a clinically complete response to chemotherapy. Synovial sarcoma is a rare soft tissue malignant tumor, most commonly affecting the extremities. While ~10% occur in the head and neck region, synovial sarcoma of the sinonasal tract is extremely rare, with only 11 cases having been reported previously. As with other sarcomas, the standard treatment is complete resection while allowing for a safe margin, but this is often difficult in the head and neck area due to the complicated anatomy there. This makes the treatment of head and neck sarcoma challenging and leads to the need for a multimodal approach in advanced cases. However, the exact efficacy of chemotherapy is not well understood. In this report, we present a case of unresectable maxillary sinus synovial sarcoma that was successfully treated by chemotherapy followed by radiation therapy. A 53-year-old Japanese man was referred to our hospital with a history of left nose obstruction over the previous couple of years. Computed tomography/magnetic resonance imaging revealed a tumor arising from the maxillary sinus that extended to adjacent tissues. A biopsy was performed, and the tumor was diagnosed as synovial sarcoma. Since the tumor was unresectable, neoadjuvant chemotherapy was administered. The response was excellent, and the tumor became undetectable under endoscopy and radiological imaging. This provided us with a clinical evaluation of “complete response”. The treatment was concluded with definitive radiotherapy and two more cycles of adjuvant chemotherapy. The patient remains free of disease 12 months after treatment. Synovial sarcoma of the head and neck is a rare entity; complete resection is the treatment of choice but (neo)adjuvant chemotherapy can be considered in unresectable cases, as we show here in the present case.
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Affiliation(s)
- Shin Saito
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
| | - Yuuichi Ikari
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
| | - Nana Nakahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
| | - Fumihiro Ito
- Department of Otorhinolaryngology - Head and Neck Surgery, NHO Tokyo Medical Center
| | - Mariko Sekimizu
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
| | | | - Kaori Kameyama
- Department of Pathology, Keio University, School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Keio University, School of Medicine
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22
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Ding L, Han A. Primary poorly differentiated monophasic synovial sarcoma of ileum mesenteries with pulmonary metastasis: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:11143-11146. [PMID: 31966464 PMCID: PMC6965853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/21/2017] [Indexed: 06/10/2023]
Abstract
Primary intra-abdominal synovial sarcomas are rare soft tissue malignancies. Herein, we present a case of poorly differentiated monophasic synovial sarcomain ileum mesenterieswith pulmonary metastasis. The patient was a 47-year-old female with a history of cough with variable expectoration and paroxysmal abdominal pain for two months. The tumor was located in ileum mesenteries and composed of monophasic spindle tumor cells with active mitosis and massive necrosis. Tumor cells were positive for vimentin and BCL-2 by immunohistochemistry staining and positive for SYT gene break apart by dual color break apart fluorescence in situ hybridization assay. The differential diagnosis includes gastrointestinal stromal tumour and other mesenchymal tumour.
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Affiliation(s)
- Li Ding
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University Guangzhou, China
| | - Anjia Han
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University Guangzhou, China
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