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Capone C, Turrini A, Rossi G, Veronesi V, Sacco C, Staffa G. Monophasic synovial sarcoma mimicking schwannoma: a case report of a rare peripheral nerve tumor and literature review. Neurol Res 2023; 45:530-537. [PMID: 36617792 DOI: 10.1080/01616412.2022.2164446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Synovial sarcomas occurring as primary nerve tumors (SSPN) are rare and only 69 cases of SSPNs are reported in literature. Despite the little data available, SSPNs differ from other SSs in some distinctive aspects such as epidemiology, location, and early onset of symptoms. SSPN are consequently underdiagnosed and easily mistaken for benign or malignant peripheral nerve sheath tumors (PNST). Therefore, cytogenetic or molecular testing becomes essential in order to make a correct diagnosis. This article deals with an extremely rare case of monophasic SSPN of the posterior cords of the right brachial plexus. To our knowledge, this is only the tenth case of intraneural synovial sarcoma involving the brachial plexus. CASE PRESENTATION We report the case of a 64-year-old man, who came to our attention due to a slow-growing painful right axillary neoformation, approximately 25 mm in size. The patient did not show any neurological impairments. Ultrasonography and constrast MRI showed a heterogeneous mass arising from the posterior cord of the right brachial plexus, resembling a schwannoma. The patient underwent total resection of tumor and capsule. Histologically, a diagnosis of monophasic synovial sarcoma was made based on histologic features and the immunohistochemical profile. CONCLUSIONS We report a rare primary synovial sarcoma of the brachial plexus. Given its rarity, the diagnosis may be challenging and requires a core biopsy or the surgical specimen to permit immune-molecular analysis. Margin-free surgery is the mainstay of curative treatment, while chemo- or radiotherapy may have a role in advanced or margin-positive neoplasms.
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Affiliation(s)
- Crescenzo Capone
- Department of Peripheral Nerve Surgery, Ospedale Civile degli Infermi, Faenza, Italy
| | | | - Giulio Rossi
- Department of Pathology, Ospedale Civile degli Infermi, Faenza, Italy
| | - Vanni Veronesi
- Department of Peripheral Nerve Surgery, Ospedale Civile degli Infermi, Faenza, Italy
| | - Carlo Sacco
- Department of Peripheral Nerve Surgery, Ospedale Civile degli Infermi, Faenza, Italy
| | - Guido Staffa
- Department of Peripheral Nerve Surgery, Ospedale Civile degli Infermi, Faenza, Italy
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Alshehri FD, Baeshen SK, Samkari AMN, Almehdar AS, Lary AI. Synovial sarcoma of the spine: A case report and review of the literature. Surg Neurol Int 2020; 11:257. [PMID: 33024595 PMCID: PMC7533099 DOI: 10.25259/sni_429_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Synovial sarcoma (SS) of the spine is a rare malignant soft-tissue tumor, and there are few reported cases. The aim of this paper is to report a rare case of spinal SS involving the paraspinal muscles, and to review all such cases reported in the literature. Case Description: In this paper, we report a rare case of spinal SS involving the paraspinal muscles in a 12-year-old girl. The patient underwent surgical excision of the mass with adjuvant radiation and chemotherapy. At the 1-year follow-up, there was no evidence of local tumor recurrence, and the patient’s symptoms had improved. In addition, we identified and reviewed 33 reported cases of SS involving the spine. Conclusion: Due to the limited number of reported cases in the literature, it is difficult to predict the outcomes of spinal SS. Further, different treatment modalities have been used to treat spinal SS. However, most of the reported cases had poor outcomes. Therefore, prospective multi-center studies are needed to further investigate the treatment strategies and outcomes for patients with spinal SS.
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Affiliation(s)
- Fayez Dhafer Alshehri
- Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Salem Khaled Baeshen
- Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Alaa Mohammed Noor Samkari
- Departments of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Makkah, Saudi Arabia
| | - Abeer Salim Almehdar
- Departments of Radiology King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Makkah, Saudi Arabia
| | - Ahmed Ibrahim Lary
- Departments of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Makkah, Saudi Arabia
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Burks SS, Puffer RC, Cajigas I, Valdivia D, Rosenberg AE, Spinner RJ, Levi AD. Synovial Sarcoma of the Nerve-Clinical and Pathological Features: Case Series and Systematic Review. Neurosurgery 2020; 85:E975-E991. [PMID: 31435657 DOI: 10.1093/neuros/nyz321] [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] [Received: 01/22/2019] [Accepted: 05/18/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Synovial sarcoma of the nerve is a rare entity with several cases and case series reported in the literature. Despite an improved understanding of the biology, the clinical course is difficult to predict. OBJECTIVE To compile a series of patients with synovial sarcoma of the peripheral nerve (SSPN) and assess clinical and pathological factors and their contribution to survival and recurrence. METHODS Cases from 2 institutions collected in patients undergoing surgical intervention for SSPN. Systematic review including PubMed and Scopus databases were searched for related articles published from 1970 to December 2018. Eligibility criteria: (1) case reports or case series reporting on SSPN, (2) clinical course and/or pathological features of the tumor reported, and (3) articles published in English. RESULTS From patients treated at our institutions (13) the average follow-up period was 3.2 yr. Tumor recurrence was seen in 4 cases and death in 3. Systematic review of the literature yielded 44 additional cases with an average follow-up period of 3.6 yr. From pooled data, there were 10 recurrences and 7 deaths (20% and 14%, respectively). Adjuvant treatment used in 62.5% of cases. Immunohistochemical markers used in diagnosis varied widely; the most common are the following: Epithelial membrane antigen (EMA), cytokeratin, vimentin, cluster of differentiation (CD34), and transducin-like enhancer of split 1 (TLE1). Statistical analysis illustrated tumor size and use of chemotherapy to be negative predictors of survival. No other factors, clinically or from pathologist review, were correlated with recurrence or survival. CONCLUSION By combining cases from our institution with historical data and performing statistical analysis we show correlation between tumor size and death.
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Affiliation(s)
- Stephen Shelby Burks
- Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Iahn Cajigas
- Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - David Valdivia
- Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Allan D Levi
- Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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Raveendran S, Kota AA, Stephen E, Pallapati SCR, Thomas BP. Synovial sarcoma of the brachial plexus - a rare tumor in a rare area: a case report. J Med Case Rep 2018; 12:334. [PMID: 30409199 PMCID: PMC6225558 DOI: 10.1186/s13256-018-1860-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Background Synovial cell sarcomas are usually seen in a juxta-articular location. However, they occur rarely in the head and neck region. Case presentation We report a rare case of brachial plexus synovial sarcoma in a 24-year old South Asian man treated successfully with surgical excision followed by radiotherapy. Conclusions Synovial sarcoma arising from the brachial plexus is rare. The treatment is multimodal with complete excision (often challenging owing to the proximity of the neurovascular structures) and adjuvant therapy.
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Affiliation(s)
| | - Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College, Vellore, 632004, India.
| | - Edwin Stephen
- Department of Vascular Surgery, Christian Medical College, Vellore, 632004, India
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Abstract
Synovial sarcoma of peripheral nerve (SSPN) is rare with only 26 cases reported in English. SSPN is often mistaken for a benign or malignant peripheral nerve sheath tumor (PNST) by clinicians and pathologists. Fifteen cases of SSPN were retrieved from the pathology files of 3 institutions. All tumors arose in a nerve based on imaging and/or operative findings and the diagnoses were histologically confirmed. Neuropathic symptoms predominated in 11 women and 4 men, 19- to 62-year-old (median, 39 years) with tumors involving the ulnar (5), median (3), peroneal (3) or sciatic (2) nerve, or the L4 or T1 nerve root (2). Tumor sizes ranged from 2 to 13 cm (median, 3.8 cm). The leading clinical diagnosis was PNST (9). Treatment was surgical (14) supplemented with radiation therapy (8) and chemotherapy (6). Fourteen tumors were monophasic and 1 was biphasic; 4 had poorly differentiated (PD) foci (1 rhabdoid). Diagnoses in 12 cases were verified by fluorescence in situ hybridization, reverse transcription polymerase chain reaction or both methods. Follow-up in 14 patients (median, 32 mo) revealed that 2/4 patients with PD tumors died with pulmonary metastases; another was alive with no current evidence of disease (NED) following 2 local recurrences, while the fourth had NED. In contrast, 9/10 patients without PD tumors were alive (7 NED) and 1 died at 12 months with pulmonary infiltrates. SSPN is under-recognized clinically and histologically as it mimics benign and malignant PNST. Molecular analysis is recommended to confirm the diagnosis. PD foci, including rhabdoid areas, may portend a worse outcome, similar to non-neural-based tumors.
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Guo A, Guo F. Sudden onset of paraplegia secondary to an unusual presentation of pediatric synovial sarcoma. Childs Nerv Syst 2016; 32:2465-2469. [PMID: 27444286 DOI: 10.1007/s00381-016-3176-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Spinal synovial sarcoma (SS) is an extremely rare malignant tumor in children. CASE REPORT We report an unusual pediatric synovial sarcoma located in the thoracic spine at T9-T10 levels. A 10-year-old boy was admitted with a 1-month history of progressive back pain and low fever for 7 days as well as sudden onset of paraplegia for 1 day. The primary diagnosis was considered for spinal inflammatory abscess; subsequently, the patient underwent total resection with a good recovery and confirmed SS by SYT-SSX gene translocation. CONCLUSION The possibility of sudden paraplegia caused by unusual SS involved in the spine should be highlighted.
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Affiliation(s)
- Ailing Guo
- Department of Neurosurgery, The First Affiliated Hospital of ZhengZhou University, Zhengzhou, 450052, Henan Province, People's Republic of China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of ZhengZhou University, Zhengzhou, 450052, Henan Province, People's Republic of China.
- Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, Jianshe East Road, No 1, ZhengZhou, HeNan Province, 450052, People's Republic of China.
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Pancucci G, Simal-Julian JA, Plaza-Ramirez E, García-Marcos R, Mayordomo-Aranda E, Botella-Asunción C. Primary extraosseous intradural spinal Ewing's sarcoma: report of two cases. Acta Neurochir (Wien) 2013; 155:1229-34. [PMID: 23686630 DOI: 10.1007/s00701-013-1739-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/22/2013] [Indexed: 12/11/2022]
Abstract
Two cases of primary extraosseous intradural spinal Ewing's sarcoma are reported with a review of the current literature. This rare neoplasm shares features with cerebral primitive neuroectodermal tumors, complicating a correct diagnosis. Gross total resection seems to be the main treatment, although adjuvant therapies could improve the prognosis. In case 1, a 56-year-old man presented with cauda equina syndrome. MRI showed an intradural tumor from L4 to S2. An emergency laminectomy was performed with gross total resection of a hemorrhagic tumor, followed by adjuvant treatment. In the second case, a 25-year-old female developed leg and lumbar pain. MRI study identified a homogeneously enhancing intradural mass at the L2-L3 level. A laminoplasty was performed, followed by tumor resection; no adjuvant treatment was administered afterwards. Immunohistochemical workup confirmed the diagnosis of Ewing's sarcoma in both cases.
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Affiliation(s)
- Giovanni Pancucci
- Department of Neurological Surgery, Hospital Universitario La Fe, Área Administrativa 5E, c/Bulevar Sur, s/n, 46026, Valencia, Spain.
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Peia F, Gessi M, Collini P, Ferrari A, Erbetta A, Valentini LG. Pediatric primitive intraneural synovial sarcoma of L-5 nerve root. J Neurosurg Pediatr 2013; 11:473-7. [PMID: 23414131 DOI: 10.3171/2013.1.peds12181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primitive intraneural synovial sarcomas are rare in children. The authors report the case of a 7-year-old girl affected by intraneural synovial sarcoma of a lumbar nerve root, the first such lesion in this location described in a child. The lesion mimicked a schwannoma clinically and radiologically. There was long-lasting leg pain in a radicular distribution, and a well-demarcated intraneural tumor was seen on MRI. On this basis, the first resection was conservative. However, histological examination documented a classic biphasic synovial sarcoma, which was confirmed by immunohistochemistry. After radical resection and adjuvant treatment, complete disease control was achieved and verified at 5-year follow-up. This case strongly suggests that early diagnosis and a multidisciplinary approach to this unusual spinal lesion are essential to achieving a better prognosis.
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Affiliation(s)
- Francesco Peia
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy
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Kim KW, Park SY, Won KY, Jin W, Kim SM, Park JS, Ryu KN. Synovial sarcoma of primary bone origin arising from the cervical spine. Skeletal Radiol 2013; 42:303-8. [PMID: 23053202 DOI: 10.1007/s00256-012-1524-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/14/2012] [Accepted: 09/12/2012] [Indexed: 02/02/2023]
Abstract
Synovial sarcoma of primary bone origin is very rare and has not been previously reported in the cervical vertebra. We report the first case of a synovial sarcoma of the cervical vertebra, presenting as an expansile osteolytic lesion in the posterior osseous elements of the C3 vertebra characteristically with prominent intratumoral vessels.
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Affiliation(s)
- Kun Woo Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Republic of Korea.
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Puffer RC, Daniels DJ, Giannini C, Pichelmann MA, Rose PS, Clarke MJ. Synovial sarcoma of the spine: A report of three cases and review of the literature. Surg Neurol Int 2011; 2:18. [PMID: 21394244 PMCID: PMC3052469 DOI: 10.4103/2152-7806.76939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 01/27/2011] [Indexed: 01/25/2023] Open
Abstract
Background: Synovial sarcoma (SS) is a rare sarcoma with distinct morphologic and genetic features, which, despite its name, does not arise from synovium. While most SSs (>80%) arise in the deep soft tissue of the extremities, up to 5% of these tumors are encountered in the body axis including the spine, mediastinum, retroperitoneum, and head/neck regions. Reports of SS located within the spinal axis have been rare to date. Materials and Methods: We searched the medical records at our institution and found three patients who were diagnosed and treated for SSs involving the spine. We also performed an exhaustive literature search using PubMed to identify all reported cases in the literature. Results: In this study, we report on three SS cases involving the spine. All three cases involved the paraspinal muscles and spinal nerve roots, with one case having a significant leptomeningeal involvement. In two cases, “smaller operations” were performed first because the lesions were thought to be benign, however, when the final pathology identified them as SSs, more radical procedures were performed. Additionally, we identified 14 cases of SSs involving the spine published in the literature and all cases are reviewed here. Conclusions: Due to limited numbers of cases, spine SS long-term outcomes are hard to quantify. The currently accepted standard of treatment for SSs starts with wide surgical excision with negative margins followed by chemotherapy and radiation. We summarize the available literature on spinal SSs and review the current treatment options available for these tumors.
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Affiliation(s)
- Ross C Puffer
- Mayo Clinic, 200 1 St SW Rochester, MN 55905, Mayo Medical School, MN 55905, USA
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Klimo P, Codd PJ, Grier H, Goumnerova LC. Primary pediatric intraspinal sarcomas. Report of 3 cases. J Neurosurg Pediatr 2009; 4:222-9. [PMID: 19772405 DOI: 10.3171/2009.3.peds08272] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sarcomas that arise from within the spinal canal are rare, particularly within the pediatric population. In general, these primary intraspinal sarcomas are highly aggressive, posing unique treatment challenges with respect to surgery and choice of adjuvant therapy. The goal must be to obtain the most complete resection possible to minimize the risk of recurrence and metastasis, while preventing potential neurological deficits that may result from aggressive surgery. Among these primary intraspinal sarcomas are malignant peripheral nerve sheath tumors and members of the Ewing sarcoma family of tumors. The authors present 3 cases of unique spinal sarcomas in children-2 malignant peripheral nerve sheath tumors in patients without neurofibromatosis and an intradural extraosseous Ewing sarcoma arising from the sensory component of a lumbar spinal nerve-and discuss their management and outcome with a review of the current literature.
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Affiliation(s)
- Paul Klimo
- Wright-Patterson Air Force Base, Ohio, USA
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