Monophasic synovial sarcoma as a cause of obstructive ileus: A case report

Comprehensive treatment of primary pelvic synovial sarcoma: A 28-month follow-up case report and review of the literature

Background

Primary synovial sarcoma originating in the pelvis is an extremely rare malignancy, and only a few cases have been reported. Usually, the tumor is detected at an advanced stage, making treatment more difficult. Lacking high-quality research, there are no consensus guidelines for the systemic treatment of the disease.

Case presentation

We admitted a 32-year-old male patient with an MRI suggestive of an 8.2 × 7.7 x 8.9 cm mass in the pelvis with bleeding. After a comprehensive evaluation, the patient underwent surgery, and postoperative pathology suggested biphasic synovial sarcoma. Once the diagnosis was clear, the patient was treated with chemotherapy, radiotherapy, and targeted therapy. Unfortunately, the patient died due to a recurrence of pelvic synovial sarcoma with multiple metastases throughout the body, with a survival period of 28 months.

Conclusion

Synovial sarcoma, a highly malignant soft tissue tumor, and primary intrapelvic synovial sarcoma are even rarer, with a poor prognosis. Ultrasound, Computed Tomography, and MRI can help doctors detect the tumor at an early stage and treat it aggressively, especially with surgical treatment, which can effectively improve the survival rate. Combined with the course of diagnosis and treatment of this case, it is possible to deepen the understanding of primary pelvic synovial sarcoma and discuss appropriate treatment strategies for this rare disease.

Pelvic Synovial Sarcoma Clinically Masquerading as an Ovarian Malignancy

Background: Synovial sarcoma, a malignant mesenchymal tumor, commonly involves the extremities and is rarely found in the pelvis. Cytology with a biphasic pattern can suggest the diagnosis of synovial sarcoma. Case Report: A 32-year-old female presented with complaints of abdominal distension. She was initially evaluated in another hospital where she underwent ultrasound-guided fine needle aspiration cytology (FNAC) of the abdominal mass. The mass was diagnosed as ovarian adenocarcinoma, and the patient underwent 3 cycles of chemotherapy. After 3 months, she was referred to our institute for surgical excision of the mass. Contrast-enhanced computed tomography of the abdomen suggested a well-circumscribed, heterogeneous, solid-cystic mass in the left adnexal region measuring 13.9 × 10 × 9.1 cm and compressing the adjacent structures. No previous radiologic investigations were available. We reviewed the FNAC slide from the outside hospital and made a preliminary diagnosis of biphasic synovial sarcoma. The patient underwent debulking surgery consisting of panhysterectomy with excision of the pelvic mass. Microscopic examination of the pelvic mass showed a biphasic tumor composed of epithelial and mesenchymal components, suggestive of synovial sarcoma. The immunohistochemistry profile supported the morphologic diagnosis. Bilateral ovaries were unremarkable. The patient received 4 cycles of adjuvant chemotherapy and is presently asymptomatic. Conclusion: Although primary pelvic synovial sarcoma is a rare occurrence, this case illustrates that synovial sarcoma can be diagnosed or at least suspected on FNAC. Because of the importance of adjuvant chemotherapy, synovial sarcoma must be high on the list of differential diagnoses of high-grade intra-abdominal masses.

Clinicopathologic features of a patient with primary monophasic synovial sarcoma of the jejunum

A case of primary synovial sarcoma of the jejunum was collected and analyzed retrospectively. A 19-year-old man who presented to hospital with abdominal pain. The CT scan showed a large mixed abdominal mass with bleeding. Laparotomy revealed that the tumor originated from the jejunum, accompanied by rupture and hemorrhage. Microscopically, the tumor was composed of spindle cells. The tumor cells demonstrated diffuse expression of vimentin, transducin-like enhancer (TLE)-1, B-cell lymphoma protein (Bcl)-2, CD99 and focal expression of epithelial membrane antigen (EMA). The presence of specific SS18 gene rearrangement was confirmed in tumor cells. The patient received 6 cycles of chemotherapy after jejunal tumor resection. And 12 months later, the patient presented pancreatic metastasis and had radiotherapy. The patient died 15 months after the diagnosis.

Primary rectal monophasic synovial sarcoma

Synovial sarcoma is a rare malignant mesenchymal neoplasm that often occurs in the extremities. Less than 70 cases of primary synovial sarcoma occurring in the digestive system have been reported. We present a case of a 48-year-old woman with a spindle cell tumor in the rectum that stained positive for AE1/3 (focal), vimentin, CD99, BCL2, EMA (focal), and MiB-1 (15%). Ultimately, the lesion was diagnosed as a primary rectal monophasic synovial sarcoma and confirmed by molecular testing for SYT/SSX1 gene fusion. Analysis of previous publications indicated that patients of advanced age or a large tumor size (≥5 cm) have a higher risk of progressing rapidly to death after diagnosis of synovial sarcoma in the digestive system.