Synovial sarcoma of the anterior abdominal wall

Abdominal Wall Synovial Sarcoma During Pregnancy-a Case Report

Synovial sarcoma is rare, aggressive, malignant mesenchymal neoplasm. The recent literature does not validate its only prevalence in the extremities of the adult population. Statistics reveal that adult population has the highest prevalence rate; 30 % of reported cases occur in the children and adolescents. It is very rare in pregnancy. Carcinomas may be diagnosed concurrently with pregnancy in approximately 0.1 % of cases, but sarcomas are rare. We report a 21-year-old woman with synovial sarcoma on anterior abdominal wall at 34th week of gestation, which was clinically diagnosed as desmoid tumor. Tumor was totally excised. After 6 months, it relapsed in the form of multiple abdominal wall swellings and ascites.

Biphasic synovial sarcoma of the abdominal wall

Synovial sarcoma arising in the abdominal wall is a rare tumor. We report a case of a 38-year-old man who complained of abdominal pain. Physical examination revealed a firm mobile mass, 25 cm in diameter, in the left lower abdominal wall. The tumor was first thought to be a sarcoma arising from the omentum or mesentery. During surgery, a large tumor was found attached to the inner surface of the abdominal wall and compressing the gastrointestinal tract. On microscopic examination the tumor corresponded to a biphasic synovial sarcoma immunoreactive for cytokeratins (AE1/AE3, 7 and 19), epithelial membrane antigen and carcinoembryonic antigen in the epithelial tumor cells, for E-cadherin especially in their glandular structure, vimentin, CD99, and CD56 in the spindle cell component and for bcl-2 protein. The tumor recurred at the same site, and clinical course progressed to death 3 months after the initial diagnosis.

Biphasic synovial sarcoma of the peritoneal cavity with t(X;18) demonstrated by reverse transcriptase polymerase chain reaction

A case of a biphasic synovial sarcoma, arising on the inner surface of the anterior abdominal wall of a 13-year-old girl, is reported. Although the tumor showed rather typical histological and immunohistochemical features for synovial sarcoma, its unusual clinical presentation and anatomical location caused diagnostic difficulty, especially with regard to differentiation from a malignant mesothelioma. Applying reverse transcriptase polymerase chain reaction (RT-PCR) analysis, the SYT-SSX2 chimeric gene transcripts that result from the translocation, t(X;18)(p11.2;q11.2), found in most synovial sarcomas could be demonstrated. Thus, this RT-PCR approach is a reliable method for confirming the diagnosis of synovial sarcomas in unusual locations.

Synovial sarcoma of the abdominal wall

BACKGROUND

Synovial sarcoma usually arises in the extremities and in close proximity to large joints. Reported examples arising in the anterior abdominal wall are rare. Because most accounts from this location consist of case reports, neither clinical nor prognostic features have been well delineated.

METHODS

Twenty-seven synovial sarcomas of the abdominal wall (SSAW), retrieved from the Soft Tissue Registry of the Armed Forces Institute of Pathology, were reviewed and analyzed retrospectively. Immunohistochemical stains were performed in 18 cases.

RESULTS

There were specimens from 12 male and 15 female patients, ranging in age from 8 to 58 years (median, 23 years). The tumors were classified as biphasic (14), predominantly monophasic fibrous (8), and poorly differentiated (5) types. The neoplasms occasionally were cystic and typically reacted, at least focally, with antibodies directed against keratin and/or epithelial membrane antigen. Eight tumors were smaller than 5 cm.; 17 tumors were 5 cm or larger in size. Dimensions were not recorded in two cases. Follow-up, ranging from 1 to 264 months, was obtained in 18 cases. Nine individuals were alive and well and eight were dead of disease at median follow-up intervals of 98 and 26 months, respectively. One patient was dead with disease, possibly secondary to chemotherapy-related causes. All nine patients who have died had clinical evidence of metastatic disease. Patients who presented with tumors 5 cm or larger had a less favorable outcome than whose with tumors smaller than 5 cm. (58% versus 40% mortality). A positive correlation was noted between increased mitotic activity and the mortality rate. Although patients with biphasic and predominantly monophasic fibrous tumors had a similar mortality rate (40% for both groups), patients with poorly differentiated synovial sarcoma fared worse (100% mortality). In general, poorly differentiated synovial sarcomas had a higher mitotic rate than either biphasic or monophasic fibrous examples. No appreciable difference in survival was evident based on the age at presentation (< 15 versus > or = 15 years of age).

CONCLUSIONS

The survival rate for patients with SSAW is similar to that reported for synovial sarcoma in general. A high mitotic rate and the poorly differentiated subtype of synovial sarcoma both were associated with a poor prognosis and, to some extent, appear interrelated. Less favorable behavior also was noted when the tumors were large (> or = 5 cm). Pluripotential or arthrogenous mesenchyme may be implicated in the pathogenesis of these tumors.

Synovial sarcoma of abdominal wall: a case report and study of tumor fine structure

A case of synovial sarcoma in the abdominal wall of a 50-year-old Iraqi woman is reported. The ultrastructure of the tumor has been studied. Eight other cases of synovial sarcoma in the abdominal wall reported in the English literature up to 1978 have been reviewed. Synovial sarcomas in the abdominal wall tend to occur with a much greater frequency in women, whereas such tumors occurring in the extremities or the neck are more common in men than woman. No ultrastructural studies of abdominal wall synovial sarcomas could be found in the English literature. The ultrastructural characters of this tumor are similar to those of such tumors arising in the usual sites and the neck. However, the present study has indicated that the light and dark cells reported by earlier workers are not limited solely to the epitheloid areas but are also present in the spindle cell zones.

Synovial sarcoma of the abdominal wall: a case report and study of its fine structure

A case of synovial sarcoma in the abdominal wall of a 50-year-old Iraq female is reported. The ultrastructure of the tumor has been studied. Eight other cases of synovial sarcoma in the abdominal wall which reported in the English literature up to 1978 have been reviewed. Synovial sarcomas in the abdominal wall tend to occur with a much greater frequency in females in contrast to such tumors in the extremities or the neck which tend to occur with a much greater frequency in males. No ultrastructure studies of abdominal wall synovial sarcomas could be found in the English literature. Ultrastructure characteristics of this tumor were similar to those arising in the usual sites and in the neck. However, the present study has indicated that the light and dark cells reported by earlier workers are not solely limited to the epitheloid areas but are also present in the spindle cell zones.

Synovial sarcoma of the abdominal wall

A case report is presented of a synovial sarcoma arising in the abdominal wall. This is the seventh such case to be reported. A brief review of the clinical and pathological features of synovial sarcoma is made.Pre-operative diagnosis of an abdominal wall synovial sarcoma is virtually impossible, but should be considered when a soft tissue swelling is found to show amorphous stippled calcification on X-ray.