Biphasic synovial sarcoma: A rare cause of axillary mass

Abstract

Synovial sarcoma is a subtype of soft tissue sarcoma which mostly affects the lower extremities, especially in young adults. Axillary involvement of the synovial sarcoma is a rarely seen clinical condition. A 68-year-old female applied with a rapidly grown palpable 4x4cm conglomerated mass in her right axilla. Except for the palpable axillary mass, her physical examination was regular. She was scanned for any distant metastasis with thoracoabdominal computerized tomography and breast ultrasonography with mammography. Tru-cut biopsy was performed on the palpable conglomerated axillary mass, and the pathological examination of the tru-cut biopsy specimen was reported as biphasic malignancy. In order to obtain a detailed examination and definite diagnosis, the mass was dissected and resected from axilla with extensive resection. Postoperative pathological examination was reported as a biphasic SS, and the surgical margins were clear. During the post-operative period, the patient had adjuvant chemoradiotherapy. There was no tumor relapse, both clinically and radiologically fourteen months after the surgery. Elder patients presenting with axillary lymphadenopathy, atypical, rare synovial sarcoma should be kept in mind. Total surgical excision should be performed, and clear margins should be obtained for the treatment of localized synovial sarcoma of the axilla.

Keywords

• Synovial sarcoma,Lymphadenopathy,Breast cancer

Aksiller kitlenin nadir bir nedeni; Bifazik sinovyal sarkom

Öz

Sinovyal sarkom sıklıkla genç erişkinlerde görülen, alt ekstremiteleri etkileyen bir yumuşak doku sarkomudur. Sinovyal sarkomun aksilla tutulumu çok nadir görülen bir klinik durumdur. 68 yaşında kadın hasta sağ aksillada ele gelen, hızlı büyüyen, konglomere, yaklaşık 4x4 cm çapında kitle yakınması ile başvurdu. Yapılan fizik muayenesinde aksiller kitle dışında ek bir özellik yoktu. Hasta torako-abdominal bilgisayarlı tomografi, meme ultasonu ve mammografi ile metastaz ve primer odak açısından araştırıldı. Tru cut biyopsi ile palpabl aksiller kitleden örnekleme yapıldı. Patolojisi bifazik malign kitle uyumlu gelen hastaya tanısal amaçlı eksizyonel biyospi yapıldı. Kitle sağlam cerrahi sınırlarla eksize edildi. Postoperatif kitle patolojisi bifazik sinovyal sarkom olarak raporlandı. Hastaya postoperatif adjuvant kemo-radyoterapi verildi. İzlem 14. ayında olan hastada klinik, radyolojik olarak nüks saptanmadı. Aksiller lenfadenopati ile başvuran ileri yaşta hastalarda sinovyal sarkom akılda tutulmalı, tedavisinde sağlam cerrahi sınırla eksizyon yapılmalıdır.

Anahtar Kelimeler

• Sinovyal sarkom,Lenfadenopati,Meme kanseri

References

1. 1. Ferrari A, Gronchi A, Casanova M, Meazza C, Gandola L, Collini P, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004;101:627–34.
2. 2. Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. Am J Roentgenol. 1995;164:129–34. doi: 10.2214/ajr.164.1.7998525.
3. 3. Palmerini E, Staals EL, Alberghini M, Zanella L, Ferrari C, Benassi MS, et al. Synovial sarcoma: retrospective analysis of 250 patients treated at a single institution. Cancer. 2009;115:2988–98. doi: 10.1002/cncr.24370.
4. 4. Wu Y, Bi W, Han G, Jia J, Xu M. Influence of neoadjuvant chemotherapy on prognosis of patients with synovial sarcoma. World J Surg Oncol. 2017;15:101. doi: 10.1186/s12957-017-1165-9.
5. 5. Arco CD , Aceñero MJF. Biphasic axillary synovial sarcoma diagnosed by preoperative fine-needle aspiration cytology, Diagnostic Cytopathology. 2017 September;45(9):857-60.
6. 6. Bergh P, Meis-Kindblom JM, Gherlinzoni F, Berlin O, Bacchini P, Bertoni F, et al. Synovial sarcoma. Identification of low and high risk groups. Cancer. 1999;85:2596-607.
7. 7. Thway K, Fisher C. Synovial sarcoma: defining features and diagnostic evolution. Ann Diagn Pathol. 2014;18:369–80.