Primary Gastric Synovial Sarcoma Diagnosed by Endoscopic Surveillance of a Gastric Ulcer

Primary gastric synovial sarcoma is rare and challenging to diagnose. We present a case of a gastric ulcer that was diagnosed as primary gastric synovial sarcoma only after surveillance endoscopy with repeat biopsies. The diagnosis was established with the identification of the pathognomonic chromosomal translocation t(X;18)(p11;q11). The patient was treated with wedge resection and has remained disease-free on surveillance imaging and endoscopy. This case demonstrates the difficulty in diagnosing primary gastric synovial sarcoma and the benefits of early disease detection.

Solitary primary pulmonary synovial sarcoma:A case report

BACKGROUND Synovial sarcoma(SS)is an uncommon and highly malignant soft tissue sarcoma in the clinic,with primary pulmonary SS(PPSS)being extremely rare.Here,we describe the clinical characteristics,diagnosis,and treatment of a solitary PPSS case confirmed via surgical resection and fluorescence in situ hybridization(FISH).CASE SUMMARY A 33-year-old man was admitted because of intermittent coughing and hemoptysis for one month,with lung shadows observed for two years.Wholebody positron emission tomography-computed tomography(PET-CT)revealed a solitary mass in the upper lobe of the right lung,with uneven radioactivity uptake and a maximum standardized uptake value of 5.6.The greyish-yellow specimen obtained following thoracoscopic resection was covered with small multinodulated structures and consisted of soft tissue.Hematoxylin and eosin staining revealed spindle-shaped malignant tumor cells.Immunohistochemistry indicated these tumor cells were CD99 and BCL-2-positive.Furthermore,the FISH test revealed synovial sarcoma translocation genetic reassortment,which confirmed the diagnosis of SS.CONCLUSION PPSS is extremely rare and tends to be misdiagnosed as many primary pulmonary diseases.PET-CT,histologic analysis,and FISH tests can be used to differentiate PPSS from other diseases.Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.

Detection of fusion gene in cell-free DNA of a gastric synovial sarcoma

Synovial sarcoma(SS) is genetically characterized by chromosomal translocation, which generates SYT-SSX fusion transcripts. Although SS can occur in any body part, primary gastric SS is substantially rare. Here we describe a detection of the fusion gene sequence of gastric SS in plasma cell-free DNA(cf DNA). A gastric submucosal tumor was detected in the stomach of a 27-year-old woman and diagnosed as SS. Candidate intronic primers were designed to detect the intronic fusion breakpoint and this fusion sequence was confirmed in intron 10 of SYT and intron 5 of SSX2 by genomic polymerase chain reaction(PCR) and direct sequencing. A locked nucleic acid(LNA) probe specificto the fusion sequence was designed for detecting the fusion sequence in plasma and the fusion sequence was detected in preoperative plasma cfD NA, while not detected in postoperative plasma cfD NA. This technique will be useful for monitoring translocation-derived diseases such as SS.

Primary renal synovial sarcoma: A case report

BACKGROUND Synovial sarcoma,a rare mesenchymal tumor type with unclear histological origin and direction of differentiation,accounts for 6%–10%of soft tissue tumors.It is mainly located near the joints and tendons of the limbs,and occurs primarily in children or young adults.Primary renal synovial sarcoma(PRSS)is very rare,accounting for approximately 1%of synovial sarcomas.It is a spindle cell tumor type affecting mesenchymal tissue,and has morphological,genetic,and clinical characteristics,and a certain degree of epithelial differentiation.It is highly malignant and has the fourth highest incidence among soft tissue sarcomas.Here,we report a case of PRSS and share some valuable information about the disease.CASE SUMMARY A 54-year-old male patient was admitted to the hospital for a space-occupying lesion in the right kidney for 2 d upon ultrasound examination.The patient had no cold or fever;no frequency,urgency or pain of urination;and no other discomfort.The results of a hemogram,blood biochemistry,and tumor markers were in the normal range.The patient was examined by computed tomography(CT),which indicated the presence of a soft tissue density shadow with a diameter of approximately 6.8 cm in the right renal pelvis area,showing uneven enhancement.Ultrasound indicated a cystic solid mass of approximately 6.8 cm×6.5 cm in the right kidney,with an unclear boundary and irregular shape.Meanwhile,color Doppler flow imaging showed dotted blood flow signals in the periphery and interior.Contrast-enhanced ultrasound(CEUS)showed"slow in and fast out"hyperenhancement of the right renal mass after contrast agent injection.The postoperative pathological diagnosis was(right kidney)synovial sarcoma.Despite postoperative adjuvant chemotherapy,tumor recurrence was detected two years later.CONCLUSION PRSS is a rare malignant tumor.To date,no characteristic imaging findings have been observed.The diagnosis is confirmed primarily through postoperative pathological immunohistochemistry and SS18(SYT)gene detection.In this case,CEUS was used preoperatively.We found that PRSS has the characteristic of"slow in and fast out"hyperenhancement,and its particular characteristics have diagnostic value.Postoperative adjuvant chemotherapy is not very effective.

Management of primary retroperitoneal synovial sarcoma: A case report and review of literature

BACKGROUND Synovial sarcoma(SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities.Nevertheless, several cases of retroperitoneal SS(RSS) have been described. We herein report a case of RSS presented in our institution.CASE SUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS.CONCLUSION RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.

Imaging findings of primary pulmonary synovial sarcoma with secondary distant metastases:A case report

BACKGROUND Synovial sarcoma(SS)accounting for 6%-10%of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs.Primary pulmonary SS(PPSS)is rare and has a poor prognosis.Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports.We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology,and shared valuable information on PPSS.CASE SUMMARY A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung.The results of a hemogram,erythrocyte sedimentation rate(ESR)and tumor markers were all within the normal range,tuberculin skin test(5 TU PPD)was negative(-).Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe.Thoracoscopic-assisted wedge resection of the right upper lobe of the lung,right upper lobe resection and lymph node dissection were performed.Nine months after surgery,ultrasound examination showed multiple metastases on the chest wall and kidney.CONCLUSION PPSS is a rare malignant lung tumor with strong invasiveness,early distant metastasis and poor prognosis.There are very few imaging reports.PPSS is often manifested as irregular tumor and calcification,and the metastases have extremely low echo on ultrasonography.Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement,manifested as“fast forward and fast regression”.

Primary orbital monophasic synovial sarcoma with calcification:A case report

BACKGROUND Synovial sarcoma is a malignant mesenchymal neoplasm with variable epithelial differentiation.Most synovial sarcoma cases are reported in young adults and can arise in any body site.Notably,primary orbital synovial sarcoma is rare.CASE SUMMARY An 8-year-old east Asian girl with 1-month history of gradual painless proptosis and lacrimation of the right eye was admitted.The patient presented with painless proptosis,downward eyeball displacement,and upward movement disorders.According to clinical manifestations,imaging examinations and postoperative immunohistochemical examinations,the diagnosis was monophasic synovial sarcoma with calcification.The patient underwent anterior orbitotomy procedure for removal of the right orbital mass under general anesthesia.The diagnosis of monophasic synovial sarcoma with calcification was confirmed finally through histological and immunohistochemical exam.The follow-up period was 6 mo,and no recurrence was observed during this period.CONCLUSION Primary orbital monophasic synovial sarcoma with calcification is a rare sarcoma,and clinical manifestations and imaging results are not specific.The tumor may present similar features as a benign tumor.Comprehensive analysis of clinical,radiological,and pathological findings is critically important for making the right diagnosis.Conventional treatment approach for synovial sarcoma is surgical resection with adjuvant or neoadjuvant radiotherapy,which is highly effective for localized tumors.

Primary intracranial synovial sarcoma with hemorrhage:A case report

BACKGROUND Synovial sarcoma(SS)is a highly malignant tumor of unknown histological origin.This tumor can occur in various parts of the body,including those without synovial structures,but mainly in and around the joints,mostly in the lower extremities.Primary intracranial SSs are remarkably rare.This paper aims to report a case of primary intracranial SS with hemorrhage.CASE SUMMARY A 35-year-old male patient suffered a headache and slurred speech during manual labor and was sent to the emergency department.Through imaging examination,the patient was considered to have high-grade glioma complicated with hemorrhage and was treated with craniotomy.Postoperative pathology revealed SS.positron emission tomography/computed tomography was performed,which ruled out the possibility of metastasis to the intracranial from other parts of the body.Postoperative radiotherapy was given to the patient,during which radiation necrosis occurred.Sixteen months after craniotomy,cranial magnetic resonance imaging revealed recurrence of the tumor.CONCLUSION Primary intracranial SS is a rare malignant tumor.Primary intracranial SS with hemorrhage and radiation necrosis should be carefully monitored during postoperative radiotherapy.Surgical resection of the tumor combined with postoperative radiotherapy and chemotherapy is currently used,but the prognosis is poor.

SYNOVIAL SARCOMA IN CHILDHOOD:CLINICAL AND RADIOLOGICAL FINDINGS

Objective: To study the clinical characteristics and radiological features of synovial sarcoma in childhood and its relation to the diagnosis and treatment. Methods: The clinical radiological features of 15 children with synovial sarcoma proved surgically and pathologically were analyzed. Results: In children, the tumor boundaries are poorly defined due to paucity of fat, and metastasis usually occurs early. Eight patients in this series had bone involvement, including: direct erosion by tumor causing cortical destruction, indirect pressure defect with sharp margin and reactive bone sclerosis and bone destruction of the primary intraosseous synovial sarcoma. Conclusion: The tumor is often misdiagnosed, the final confirmed diagnosis must be made by histological examination with imaging findings. It is emphasized that the patients should be treated with radiotherapy and chemotherapy preoperatively and postoperatively.

Synovial sarcoma in the plantar region: A case report and literature review

BACKGROUND Synovial sarcoma (SS),a rare malignant soft tissue tumor whose histological origin is still unknown,often occurs in limbs in young people and is easily misdiagnosed.CASE SUMMARY We report a 24-year-old man who sought treatment for plantar pain thought to be caused by a foot injury that occurred 4 years prior.Currently,he had been seen at another hospital for a 1-wk history of unexplained pain in the left plantar region and was treated with acupuncture,a kind of therapy of Chinese medicine,which partly relieved the pain.Because of this,the final diagnosis of biphasic SS was made after two subsequent treatments by pathological evaluation after the last operation.SS is rarely seen in the plantar area,and his history of a left plantar injury confused the original diagnosis.CONCLUSION This study shows that pathological and imaging examinations may play a vital role in the early diagnosis and treatment of SS.

Multimodality-imaging manifestations of primary renal-allograft synovial sarcoma:First case report and literature review

BACKGROUND Primary renal synovial sarcoma (PRSS) is an extremely rare tumor with a poor prognosis. Its imaging and immunohistochemical characteristics may overlap with other renal tumors, which renders its early diagnosis in a dilemma. The diagnosis of primary renal synovial sarcoma requires histopathology and the confirmation of SYT-SSX gene fusion using molecular techniques. Cases of primary renal synovial sarcoma have been previously reported in the literature. However, to our knowledge, primary renal allograft synovial sarcoma was never described. CASE SUMMARY A 43-year-old male patient who underwent kidney transplantation 9 months ago came to our hospital for regular follow-up. Traditional ultrasonography revealed multiple hypo-echo neoplasms in the renal allograft. Contrast-enhanced computed tomography (CECT) showed slightly hyper-density masses with slow homogeneous enhancement. Ultrasound-guided biopsy was conducted for accurate pathological diagnosis. The neoplasms were diagnosed as synovial sarcoma by pathological, immunohistochemical, and genetic analyses. Positron emission tomography/CT showed no evidence of metastasis. At approximately one week post biopsy, contrast-enhanced ultrasound was conducted to eliminate active hemorrhage. One month later, CECT showed that the biggest neoplasm grew from 3.3 cm to 5.7 cm in diameter. Parametric imaging was conducted with SonoLiver CAP to conduct further quantitative analysis, which showed that the enhancement pattern was heterogeneous hyper-vascular enhancement. Radical surgical resection of the whole renal allograft and ureter was conducted without additional adjuvant chemotherapy or external radiotherapy. Anlotinib was chosen for targeted therapy with a good response. CONCLUSION We propose multimodality imaging for accurate diagnosis of renal allograft synovial sarcoma especially when it is formed by spindle-shaped cells.

Commentary on"Primary orbital monophasic synovial sarcoma with calcification:A case report"

The present letter to the editor is related to the study titled“Primary orbital monophasic synovial sarcoma with calcification:A case report”.Orbital synovial sarcoma is one of the rare intraorbital masses seen in adult and pediatric populations.Some case reports in the literature revealed that synovial sarcoma may contain calcifications.Therefore,it is important to make differential diagnosis among calcified orbital masses in childhood.

Cystic Synovial Sarcoma of the Lower Extremity: A Case Report and Review of the Literature

Synovial sarcomas are rare tumors which most often present in the distal extremities of young adults and children. There are unique clinicopathologic features of this tumor which lend themselves to multidiscipli- nary treatment and translational research. We present a case of a primarily cystic synovial sarcoma and pro- vide a thorough review of the available literature.

Synovial Sarcoma Arising in the Chest Wall Following Ten Years Unexplained Chest Pain

Synovial sarcomas are the fourth most common malignant soft-tissue tumors, and typically develop in para-articular locations of the extremities. Other less common sites include the head and neck, abdominal wall, intra-abdominal cavity, and mediastinum. However, the occurrence of these tumors in the chest wall is rare. In this article, we report the interesting case of a 31-year-old male with monophasic synovial sarcoma arising in the left anterior chest wall, who had sustained an unexplained, intermittent sharp pain in the area over a period of ten years before the development of the tumor. We discuss his clinical and radiological findings and include a brief review of the literature.

Synovial Sarcoma of Hand Presenting as A Cystic Mass

Synovial sarcoma is a rare mesenchymal tumor. It occurs predominantly in the extremities especially in the region of the knee. The localization in palm hand is rare. We report a case of a 23 year-old man who present a monophasic synovial sarcoma of the left hand which presented as a painless cystic nodule. A surgical excision was performed. The result was good without recurrence. The synovial sarcoma is a rare malignant neoplasm that should be considered in the differential diagnosis of spindle neoplasms of hand.

Primary Synovial Sarcoma of the Kidney: A Case Report

Synovial sarcoma originating from the kidney is extremely rare. A 13-year-old girl presented with a mild left flank pain of one-week duration, with no associated history of hematuria or any other systemic symptoms. Computed tomography (CT) demonstrated a 6 × 13 × 9 cm mass in the left kidney. No soft tissue or extrarenal masses were identified. The patient received a combined of treatment with doxorubicin and ifosfamide. A radical nephrectomy was performed in the left kidney with no complications. Postoperative pathology revealed post-chemotherapy residue of monophasic spindle cell synovialosarcoma of the left kidney. She received a combined treatment with doxorubicin and ifosfamide in concomittance with external radiation therapy. The patient was re-examined 4 months after surgery. An abdominal and pulmonary CT found no recurrence or metastasis.

Synovial sarcoma:a rare presentation of parapharyngeal mass

Synovial sarcoma is a rare soft tissue sarcoma of the head and neck region involving the parapharyngeal space.The diagnosis of synovial sarcoma can be very challenging to the pathologists.We present a rare case of parapharyngeal synovial sarcoma in a young female patient who had a two-month history of left cervical intumescent mass at level II.The fine needle aspiration cytology of the mass was proved inconclusive.Transcervical excision of the mass was performed and the first case of parapharyngeal sarcoma was identified in our center by fluorescence in situ hybridization(FISH) technique.Repeat imaging revealed residual tumor.The patient successfully underwent a second excision of the residual tumor and received adjuvant radiotherapy.

Massive recurrent synovial sarcoma of the neck:a case report

We report a rare case of massive recurrent synovial sarcoma of the neck in a 25-year-old woman.Physical exami- nation showed a 30×28 cm well-defined subcutaneous mass in the left cervical region,compressing the trachea to the right. Systemic examination revealed no metastasis to other organs.The diagnosis of sarcoma was established by percutaneous needle biopsy.Branches of the left subclavian artery and the left external carotid artery were found to supply the tumor,their embolization successfully shrank the tumor preoperatively allowing subsequent resection.Pathological analysis confirmed the diagnosis of synovial sarcoma.The patient was without recurrence 12 months after operation.

Clinical Pathological Analysis of Synovial Sarcoma

OBJECTIVE To investigate the clinical diagnosis and differential diagno- sis of synovial sarcoma (SS). METHODS A total of 41 paraffin-embedded synovial sarcoma samples were examined by H&E staining, immunohistochemistry staining and the re- verse transcriptase polymerase chain reaction (RT-PCR), in order to provide a scientific bases for diagnosis and differential diagnosis. RESULTS Twelve cases were a biphasic type, 22 cases were a mono- phasic fibrous type, and 7 cases were a poorly differentiated type. Thirty-six cases were both CK (and/or EMA) and Vim positive. Five cases were only Vim positive. A SYT-SSX fusion gene was detected in 18 cases by RT-PCR. CONCLUSION By observation of the histomorphology, immunohisto- chemistry markers and detection of a SYT-SSX fusion gene, we can make a clinical pathological diagnosis of synovial sarcoma.

Testicular Synovial Sarcoma:A Case Report

This paper reports a case of testicular synovial sarcoma with molecular genetic analysis.A 24-year-old male presented with painless scrotal mass.Ultrasonography showed a heterogeneous mass of 66 mm×34 mm in size involving the inguinal region.Histological examination of a surgical biopsy showed a gradeⅢmonophasic growth pattern of spindle cell proliferation.Immunohistochemical analyses indicated positive staining for pancytokeratine and epithelial membrane antigen.Cytogenetic analysis showed the presence of CYT-SSX1 mutation,and CT scan showed non-specific pleural micro-nodules with a size of 7.5 mm.The patient had an extended left orchidectomy but was lost to follow-up for 1 year.A local recurrent scrotal mass of 32 mm×25 mm,multiple inguinal lymph nodes,and increased pleural nodules,which were confirmed by histological examination,were treated with three cycles of adriamycine and ifosfamide chemotherapy,surgical resection,and radiotherapy with complete response.After 3 months,the patient developed local recurrence and pulmonary metastases that did not respond to second-line chemotherapy based on gemcitabine and paclitaxel.The patient had dyspnea at the time of this writing and chest pain,and is under third-line chemotherapy based on Deticene after 30 months of following up.This patient died on November 16,2012 after a resperatory failure and malignant plural effusion. Synovial sarcoma should be considered in the differential diagnosis of soft tissue tumor and it should be aggressively treated to improve prognosis.Although our patient has shown numerous factors of bad prognosis,he has had a relatively long survival time.