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Jayakrishanan R, Valakkada J, Ayyappan A, Poyuran R, Pitchai S. Femoral Vein Intravascular Synovial Sarcoma Mimicking Primary Deep Vein Thrombosis-A Rare Cause of Deep Vein Thrombosis. Indian J Radiol Imaging 2024; 34:156-159. [PMID: 38106856 PMCID: PMC10723955 DOI: 10.1055/s-0043-1771521] [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: 12/19/2023] Open
Abstract
Synovial sarcomas are rare malignant mesenchymal soft tissue tumors. We presented the case of a 53-year-old woman patient presenting with acute deep vein thrombosis, later diagnosed as a deep synovial sarcoma of the femoral vein wall. The tumor was identified through cross-sectional magnetic resonance angiography and computed tomography, followed by ultrasound-guided core biopsy. The case report emphasized the importance of considering the possibility of an intravascular neoplasm mimicking thrombus, particularly if calcifications, vein expansion with intravascular cystic spaces, fluid-fluid levels, and septations within a thrombosed vein are seen in imaging.
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Affiliation(s)
- R. Jayakrishanan
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jineesh Valakkada
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Anoop Ayyappan
- Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Shivanesan Pitchai
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Yan H, Zhou C, Yan F, Wen X, Luo Y. Case 290: Intravascular Cystic Synovial Sarcoma. Radiology 2021; 299:730-735. [PMID: 34029167 DOI: 10.1148/radiol.2021192863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
History A 26-year-old man presented with a 1-month history of chest pain, a palpable and painful right inguinal mass, and edema in the right lower extremity. One month earlier, he started to experience left chest pain with no cough. Pulmonary CT angiography (CTA) revealed a left lower lobe segmental pulmonary embolus. The local hospital made a diagnosis of pulmonary embolism. He received anticoagulants, and his chest pain was gradually relieved. At the time of current presentation, the patient was experiencing right lower extremity swelling and pain. Physical examination revealed a 4 × 3 cm palpable right inguinal mass with no redness. His medical history and family history were negative. The results of laboratory work-up were normal, with a d-dimer level of 0.16 mg/L fibrinogen equivalent units (reference range, <0.46 mg/L) and an international normalized ratio of 2.45 (therapeutic range, 2.0-3.0 for a patient taking warfarin), except the prothrombin time was 28.2 seconds (reference range, 9.6-12.8 seconds) and the activated partial thromboplastin time was 52.2 seconds (reference range, 24.8-33.8 seconds). Echocardiography, chest radiography, chest CT, and contrast-enhanced (CE) CT revealed no abnormalities. The patient underwent right lower extremity vascular conventional US (Philips IU22; Philips) with an L9-3 probe (3-9 MHz, venous condition) and contrast-enhanced US (1.5-2.0 mL, SonoVue; Bracco) with an intravenous bolus injection at the initial evaluation. Two days later, noncontrast and contrast-enhanced CT images of the lower abdomen (1.5 mL per kilogram of body weight, 300 mg/mL iomeprol, Iomeron; Bracco) were acquired for further evaluation.
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Affiliation(s)
- Hualin Yan
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Chenyun Zhou
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Feng Yan
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Xiaorong Wen
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Yan Luo
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
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Severino R, Severino P. Reasons why a second radiological opinion is advisable: a case report of a misreported crural synovial cell sarcoma. J Surg Case Rep 2017; 2017:rjx046. [PMID: 28458852 PMCID: PMC5400482 DOI: 10.1093/jscr/rjx046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/01/2017] [Indexed: 11/12/2022] Open
Abstract
Synovial sarcoma (SS) is a rare condition that accounts for 5–10% of all soft-tissue sarcomas (STS). SS locates most frequently near the joints, in particular at the lower extremities, but it can also occur in other locations. We report a case of a 42-year-old male complaining of a slow-growth mass on his right thigh, reported as a femoral nerve shwannoma on the basis of the preoperative radiological investigations, which revealed to be a monophasic SS on the histological examination. During the surgical procedure, the assistance of vascular surgeons was required to reconstruct the wall of the femoral vein underlying the tumor, that was pathologically thickened, and communicated with the tumoral capsule. Although extremely rare, SS should be considered in the differential diagnosis of peripheral nerve sheath tumors, in particular if next to a large vein at the lower extremities.
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Affiliation(s)
- Rocco Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy.,Department of Neurosurgery, 'Federico II' University, Naples, Italy
| | - Paolo Severino
- Department of Neurosurgery, Anthea Hospital, Bari, Italy
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Schreiner M, Sanad W, Pfitzner BM, Baumann G, Knebel F. A primary intravascular synovial sarcoma causing deep-vein thrombosis and pulmonary embolism in a 20-year-old woman. ACTA ACUST UNITED AC 2015; 22:e387-90. [PMID: 26628882 DOI: 10.3747/co.22.2315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary intravascular synovial sarcoma is a rare malignancy with only a few cases documented in the literature. On presentation, this tumour usually resembles a deep venous thrombosis (dvt) or pulmonary embolism (pe). Here, we report the case of a 20-year-old woman complaining of shortness of breath who had a history of dvt 6 weeks before presentation at our institution. Vascular ultrasound detected a suspicious mass in the right groin, which was identified as a monophasic synovial sarcoma by surgical biopsy. The tumour extended from the right superficial femoral vein into the common iliac vein, profound femoral vein, and great saphenous vein. It caused pe with near-total occlusion of the right pulmonary artery. After initial treatment on the cardiac intensive care unit, the patient was referred to the oncology department for neoadjuvant radiochemotherapy with doxorubicin-ifosfamide according to the Interdisziplinäre Arbeitsgemeinschaft Weichteilsarkome [Interdisciplinary AG Sarcomas] protocol and surgical resection of the tumour. No signs of tumour recurrence were found during the subsequent course of the disease, but the patient died from treatment complications approximately 15 months after initial presentation. This case underlines the importance of screening for malignancies even in young patients presenting with dvt or pe. We also recommend whole-leg compression ultrasonography in patients with suspected dvt or pe (as opposed to venography or simple four-point ultrasound examination in the groin and popliteal fossa) to detect possible underlying causes for thrombosis.
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Affiliation(s)
- M Schreiner
- Department of Internal Medicine, Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; ; Department of Internal Medicine, Bundeswehr Hospital, Berlin, Germany
| | - W Sanad
- Department of Internal Medicine, Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - B M Pfitzner
- Pathology Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Baumann
- Department of Internal Medicine, Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - F Knebel
- Department of Internal Medicine, Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Maekura T, Shimizu S, Kawaguchi T, Morimoto M, Okuma T, Matsui H, Atagi S. Intravascular synovial sarcoma of the pulmonary artery with massive pleural effusion: report of a case with a favorable response to Ifosfamide chemotherapy and palliative radiation therapy. Intern Med 2015; 54:1095-8. [PMID: 25948355 DOI: 10.2169/internalmedicine.54.3624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Synovial sarcoma (SS) commonly arises in the para-articular soft tissue; however, very few cases of intravascular SS have so far been reported. We herein describe a case of pulmonary artery SS with massive pleural effusion. A biopsy of the pleural lesions showed uniform short spindle cell proliferation, while the SYT-SSX fusion gene, which is preceded by chromosomal translocation t(X;18)(p11;q11), was detected using reverse transcription-polymerase chain reaction. Treatment with ifosfamide chemotherapy and palliative radiation therapy was effective in reducing the growth of the tumor in the pulmonary artery and pleural lesions, indicating that this regimen may be useful for the treatment of unresectable SS in the pulmonary artery.
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Affiliation(s)
- Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
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Oike N, Ogose A, Kawashima H, Umezu H, Inagawa S. Extraskeletal myxoid chondrosarcoma arising in the femoral vein: a case report. Skeletal Radiol 2014; 43:1465-9. [PMID: 24818862 DOI: 10.1007/s00256-014-1897-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/27/2014] [Accepted: 04/11/2014] [Indexed: 02/02/2023]
Abstract
Soft tissue tumors arising in deep veins of the extremities are uncommon, although a few cases of synovial sarcoma or leiomyosarcoma arising in the femoral vein have been documented. However, to the best of our knowledge, an extraskeletal myxoid chondrosarcoma (EMC) arising in the femoral vein has not been reported in the English literature. We report a case of EMC arising in the femoral vein of a 70-year-old man who presented with right leg edema and was diagnosed with a deep venous thrombosis (DVT) by computed tomography (CT). Magnetic resonance imaging (MRI) revealed a mass in the right proximal thigh that was diagnosed as myxomatous sarcoma by aspiration cytology, and anticoagulant therapy was initiated. The mass was surgically resected en bloc, including the femoral vein and surrounding soft tissue, and the femoral artery was preserved. The femoral vein was not reconstructed. The histologic diagnosis was an extraskeletal myxoid chondrosarcoma. The patient received postoperative local radiation treatment, with a total dose of 60 Gy, and is currently doing well with no evidence of local recurrence or metastasis at 8 months after surgery. In summary, this case report shows that EMC can arise in the femoral vein, and that reconstruction of the femoral vein is not always necessary during surgery for soft tissue tumors.
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Affiliation(s)
- Naoki Oike
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 757-1 Asahimachi-dori, Niigata, 951-8510, Japan,
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Tuncer ON, Erbasan O, Golbasi I. Primary intravascular synovial sarcoma: case report. Heart Surg Forum 2012; 15:E297-9. [PMID: 23092672 DOI: 10.1532/hsf98.20111159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Synovial sarcoma (SS), a mesenchymal spindle cell tumor, displays variable epithelial differentiation, including glandular formation, and features a specific chromosomal translocation, t(X;18)(p11;q11). SS accounts for 5% to 10% of soft-tissue sarcomas. These tumors occur mostly in the joints, especially near the knee, but they also occur in other locations. Primary intravascular SS (IVSS) are extremely rare; only 6 well-documented cases have been reported in the English literature. We describe a new case of primary IVSS of the superior vena cava (SVC) in a 16-year-old boy. A transthoracic echocardiogram confirmed a large (4.8 × 4.6 cm) circumscribed mass filling the right atrium, as well as a moderate pericardial effusion. The mass extended from the SVC to the tricuspid valve but did not prevent valve coaptation. Surgery via a transatrial approach revealed a huge mass (8 to 12 cm) attached to the SVC via a 5-mm pedicle. The tumor was excised, and the patient experienced an uneventful postoperative course. Fluorescence in situ hybridization analysis revealed the presence of the SS-specific translocation.
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Affiliation(s)
- Osman Nuri Tuncer
- Department of Cardiovascular Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkey. dr_
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Schoneveld JM, Debing E, Verfaillie G, Geers C, Van den Brande P. Deep Venous Thrombosis and Pulmonary Embolism Caused by an Intravascular Synovial Sarcoma of the Common Femoral Vein. Vasc Endovascular Surg 2012; 46:693-5. [DOI: 10.1177/1538574412460770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism. Physical and radiological examinations showed besides the thrombosis a tumor arising from the right common femoral vein involving the bifurcation of the common femoral artery. At surgery, en block resection of the tumor including the deep femoral vein and arterial bifurcation was done with an arterial reconstruction using a synthetic graft. Histopathological examination revealed an intravascular SS of the common femoral vein. The mainstay of curative therapy is complete surgical resection of all tumor manifestations with negative histological margins.
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Affiliation(s)
- J. M. Schoneveld
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - E. Debing
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - G. Verfaillie
- Department of Thoracic Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C. Geers
- Department of Pathology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - P. Van den Brande
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Lin YJ, Yang QX, Tian XY, Li B, Li Z. Unusual primary intracranial dural-based poorly differentiated synovial sarcoma with t(X; 18)(p11; q11). Neuropathology 2012; 33:75-82. [DOI: 10.1111/j.1440-1789.2012.01320.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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