BIPHASIC SYNOVIAL SARCOMA OF THE ARM - CASE REPORT

Presentation: L.H. is a 31 years old female caucasian, agronomist, non smoker and with no previous diseases who has noticed a painless lump on her left triceps. She has consulted with a dermatologist, who requested her an arm ultrasound that described a focal nodular hypo echoic and well delimited image (3,7 x 2,9 x 2,0 cm), suspected as a nervous sheath neoplasia, and suggesting a MRI as complementary exam. So the patient has been referenced to a Oncologist Surgeon and also performed the MRI, which has described a solid elongated lesion with a T1 hypo signal and T2 hyper signal, strongly paramagnetic contrast highlighted, located in between the muscular plans with no apparent bone or ligaments invasion (6,1 cm on its largest axis). Then a incisional biopsy was performed, with a pathological examination describing partially encapsulated biphasic neoplasia with epithelial (glandular) and mesenchymal (sarcomatous) components; the immunohistochemistry was compatible with biphasic synovial sarcoma. The CTs were performed for diseases staging and showed no evidence of metastatic disease. The complete excision of the lesion was then performed, with pathological examination with free margins, confirming the diseases histology. The patient underwent adjuvant therapy (4 cycles of Epirrubicin, Ifosfamide and Mesna) and repeated the CTs after, that showed just a nodular hepatic image suggesting nodular focal hyperplasia. Discussion: synovial sarcomas represent a rare and aggressive type of neoplasia (5-10% of soft tissue sarcomas). They generally affect young adult caucasian male people, more frequently on inferior members. The most common presentation is asymptomatic, except for a lump of significant size at the diagnosis. The most common metastasis site are lymphonodes and lungs. Significant differences were not observed between mono or biphasic subtype courses of disease in previous studies. The treatment is based on surgery with adjuvant chemotherapy. Neoadjuvant treatment may be or not performed. Final considerations: the described case report represents a rare situation based not only on the histological diagnosis but also on the patients profile, considering that this disease is more common on male sex and inferior members.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019