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Sahito B, Ahmed S, Khan FH, Abro A, Kumar J, Khan MW, Oduoye MO. Fungating synovial sarcoma at the posterior aspect of neck: a case report. J Med Case Rep 2024; 18:440. [PMID: 39267156 PMCID: PMC11395186 DOI: 10.1186/s13256-024-04747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/25/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce. CASE PRESENTATION A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later. CONCLUSIONS The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.
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Affiliation(s)
| | - Sajjad Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Awais Abro
- Dow University of Health Sciences, Karachi, Pakistan
| | - Jugdesh Kumar
- Dow University of Health Sciences, Karachi, Pakistan
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Siddiqui A, Chua N. Do Posterior Neck Lumps Need Ultrasound Evaluation: A Case Series of 623 Neck Ultrasound Studies at a Single Institution. J Prim Care Community Health 2024; 15:21501319241271284. [PMID: 39105339 PMCID: PMC11304483 DOI: 10.1177/21501319241271284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Neck lumps are a common presentation to primary care services. The aetiology of posterior neck lumps is poorly explored in the literature, and therefore remain a concern to patients and clinicians. This often results in an urgent referral for ultrasound assessment. The authors of this study sought to evaluate the aetiology of posterior neck lumps from a radiological perspective, to assess whether ultrasound can be used as a useful adjunct, rather than a first-line urgent investigation. METHODS A retrospective case series was carried out, examining all primary care referred ultrasound studies for assessment of posterior neck lumps, performed at a single institution in Essex, United Kingdom, over a period of over 10 years dating between 2nd February 2012 to 8th November 2022. Data was collected on: patient age at the time of study, patient sex, whether the lump was single or multiple as palpated and documented by the primary care physician, size of the lump to the nearest 0.5 cm as documented on ultrasound using the longest dimension, sonographic diagnosis and any follow up imaging (not limited to ultrasound). RESULTS A total of 623 neck ultrasounds were performed on 615 adults. Of the overall radiological diagnoses made from the 623 scans, 555 (89.09%) scans were benign, 63 (10.11%) scans had no lump found on sonography, and 3 (0.48%) scans showed malignancy. In the remaining 2 (0.32%) scans, the lump was deemed indeterminate. The most common aetiologies for benign lumps were due to: normal lymph nodes (n = 263; 42.21%), lipomas (n = 152; 24.39%), and benign dermal cysts (n = 105; 16.85%). All 3 malignant cases had co-existing anterior and posterior neck lumps. CONCLUSIONS Given that the overwhelming majority of posterior neck lumps in our study had benign findings, we propose that patients with solitary or even multiple posterior neck lumps alone, regardless of size can either be investigated routinely or can be reassured depending on other clinical examination characteristics. Patients who have the presence of co-existing anterior and posterior neck palpable neck lumps justifies urgent or 2-week wait radiological investigation.
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Affiliation(s)
- Atif Siddiqui
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, Chelmsford, UK
| | - Nicholas Chua
- Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Broomfield, Chelmsford, UK
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Metastatic pulmonary synovial sarcoma: A double coincidence: Case report. Radiol Case Rep 2022; 18:878-881. [PMID: 36589488 PMCID: PMC9798112 DOI: 10.1016/j.radcr.2022.11.058] [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: 11/02/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Synovial sarcomas are considered as one of the most aggressive neoplasms that account for approximately 8% of all soft tissue sarcomas; they are mainly localized in soft tissues of the extremities and joints and rarely occur in the thorax. In this case report, we describe a 34-year-old woman presenting a chest pain with a chest radiography showing a mass lesion occupying two-thirds of the right hemi-thorax. A malignant pulmonary tumor was suspected after CT imaging revealing a bilateral renal metastasis, and then a spindle-cell carcinoma was thought-about. The post-operative pathological analysis of the main mass confirmed the diagnosis of a pulmonary synovial sarcoma.
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Sebanayagam V, Alkassis S, Alshare B, Thati N. Tension Pneumothorax: Is it Sarcoma or Pazopanib? Cureus 2020; 12:e10945. [PMID: 33200058 PMCID: PMC7661012 DOI: 10.7759/cureus.10945] [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] [Indexed: 11/05/2022] Open
Abstract
Synovial sarcomas are rare malignant tumors that originate from primitive pluripotent mesenchymal stem cells that look similar to the developing synovium, but are histologically unrelated to it. Sarcomas commonly metastasize to the lungs and surrounding pleura, with a documented incidence as high as 85% for pleural-based metastases. The incidence of spontaneous pneumothorax in patients with sarcomas is only 1.9%, with synovial sarcoma being the third most common type of sarcoma associated with pneumothorax. While surgical resection is usually the treatment for localized primary synovial cell sarcoma, metastatic disease requires systemic therapy, mainly chemotherapy. Failure of chemotherapy calls for the use of targeted therapeutic agents such as pazopanib. Pazopanib has been linked to the incidence of spontaneous pneumothorax in previous case studies. However, primary research fails to establish a statistically significant causal association. Research shows that pneumothorax can result from lung metastases independent of therapeutic side effects. We report a case of synovial sarcoma of trapezius origin with secondary lung metastases, and development of pneumothorax after pazopanib treatment. We discuss the incidence of pneumothorax as a medication side effect versus independent effect of natural disease progression, and how this plays role in deciding when to continue using a medication in the face of complications.
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Affiliation(s)
- Vinoja Sebanayagam
- Hematology and Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Samer Alkassis
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Bayan Alshare
- Hematology and Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Neelima Thati
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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Atodaria KP, KishorkumarVithalani N, Bharambe AG, Mishra BC, Chauhan KM. A Rare Case of Synovial Sarcoma Involving the Brachial Plexus, Treated with Wide Local Excision and Reconstructed with Sural Nerve Grafts. Indian J Surg Oncol 2020; 10:435-436. [PMID: 32831528 DOI: 10.1007/s13193-019-00883-z] [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: 04/23/2018] [Accepted: 01/22/2019] [Indexed: 11/26/2022] Open
Abstract
This is a case report of monophasic synovial sarcoma involving right brachial plexus. Clinical and radiological examination is not very useful in diagnosis. Histopathology showed spindle cells with occasional mitotic figures. Immunohistochemistry showed positivity for EMA, S-100, Mic-2, Bcl-2, Calponin, TLE-1 and CD-56. Chromosomal translocation t (X;18) (p11.2;q11.2) and chimeric fusion proteins SYT/SSX1 or SYT/SSX2 are formed. Wide local excision of the tumour with involved brachial plexus and later reconstruction of the brachial plexus using sural nerve grafts was done. Patient showed full recovery. Wide excision and radiotherapy is the accepted mode of treatment.
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Affiliation(s)
| | | | | | | | - Keshvi Mahendrasinh Chauhan
- Bharat cancer Hospital and Research Center, Surat-Bardoli Road, Saroli, Opp. HP Petrol Pump, Surat, Gujarat 395010 India
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Concurrent Papillary Thyroid Carcinoma and Synovial Carcinoma of the Neck in an Adult Male. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:69-72. [PMID: 30783603 PMCID: PMC6368986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Synovial sarcoma makes up 8-10% of all soft tissue sarcomas, and constitutes 3-10% of all sarcomas occurring in the head and neck region. It shows male predominance (3:2), and the mean age of presentation is 30 years. CASE REPORT A 51-year-old gentleman presented with right-sided neck swelling which had been progressively increasing in size for the past 2 years. A computed tomography (CT) scan revealed a large heterogeneously enhancing mass on the right side of the neck measuring 7.5 × 6.2 cm. Biopsy of an enlarged node revealed papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with right neck dissection. Final histopathology revealed a papillary carcinoma of the thyroid, and the right-sided mass was shown to be monophasic synovial sarcoma. CONCLUSION We present a case of a concurrent pathology of neck papillary thyroid carcinoma with monophasic synovial sarcoma. We experienced difficulty in diagnosis and misdirection due to raised C-reactive protein (CRP) levels, until final histopathology of the neck mass.
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Hu PA, Zhou ZR. Clinical, pathological and unusual MRI features of five synovial sarcomas in head and neck. Br J Radiol 2015; 88:20140843. [PMID: 25945512 PMCID: PMC4628455 DOI: 10.1259/bjr.20140843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Synovial sarcoma (SS) of the head and neck is an unusual malignancy. This article documents five SSs in this region. Methods: All the patients underwent MR examinations. Four lesions received surgical ablation; one was treated with radiotherapy before surgery. The clinical, pathological and MRI features were reviewed. Results: Four of all five cases were monophasic fibrous-type SS, and the other one was biphasic type that was the fourth documented SS located in the nasopharynx. The symptoms were varied. All the masses were well defined, mainly homogeneous and solid; three of them arose adjacent to the minor joint. The mass parenchyma showed isointense signal on T1 weighted imaging similar to that of the skeletal muscle and hyperintense signal on T2 weighted imaging with remarkable enhancement. Two cases were found with fibrous septum, one with haemorrhage and one with cystic degeneration. Epithelial membrane antigens (EMAs) were all positive. The positive rate of cytokeratin (CK), part pan-CK antibody (AE1/3) and vimentin (Vim) were 50%, 75%, 75%, respectively. Conclusion: Well-defined head and neck masses frequently arise adjacent to the minor joint, which are mainly homogeneous and solid, with isointense signal on T1 weighted MRI and hyperintense signal on T2 weighted MRI, and remarkable enhancement should evoke the diagnosis of SS. The positive staining of Vim\AE1/3\EMA and CK facilitates the final diagnosis. Advances in knowledge: The article documents the fourth SS involving the nasopharynx; other locations were also uncommon; three of them arose adjacent to the minor joint. The clinical, pathology and uncommon MR features of SS in the head and neck are also documented.
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Affiliation(s)
- P A Hu
- 1 Department of Radiology, Children's Hospital of Fudan University, Shanghai, China
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Rea G, Somma F, Valente T, Antinolfi G, Di Grezia G, Gatta G. Primary mediastinal giant synovial sarcoma: A rare case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Zhou Y, Dong W, Zou F, Zhou DA, Ma JA. Primary giant mediastinal synovial sarcoma of the neck: A case report and review of the literature. Oncol Lett 2013; 7:140-144. [PMID: 24348836 PMCID: PMC3861583 DOI: 10.3892/ol.2013.1649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 10/23/2013] [Indexed: 12/03/2022] Open
Abstract
Synovial sarcomas commonly occur in the soft tissue of the extremities, while a primary occurrence in the mediastinum is quite rare. The current study reports the case of an 11-year-old male who presented with a neck mass, which computed tomography showed was due to a giant mediastinal mass involving the thyroid gland. The tumor was resected by thoracotomy and diagnosed as monophasic synovial sarcoma by histopathology. The patient received adjuvant combination chemotherapy and radiation therapy following surgery. At the 3-month follow-up, no local tumor recurrence was found. The present case report highlights the significance of recognizing the unusual presentation and clinical manifestation of synovial sarcoma to aid clinical management. Written informed consent was obtained from the patient’s family.
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Affiliation(s)
- Yan Zhou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Wen Dong
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Fangwen Zou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Dong-Ai Zhou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jin-An Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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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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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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