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Monophasic synovial sarcoma presenting as a primary ileal mass: a case report and review of the literature

Alsharief AN, Fageeh M, Alabdulkarim Y - J Med Case Rep (2012)

Bottom Line: There are few cases reported in other areas.We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction.Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract.

Affiliation: King Fahad Medical City, Riyadh, Saudi Arabia, P,O, Box 59046, Riyadh 11525 Kingdom of Saudi Arabia. Yalabdulkarim@gmail.com.

ABSTRACT

Introduction: Synovial sarcoma is a rare malignant mesenchymal tumor mainly arising in the peri-articular tissue in young adults. There are few cases reported in other areas.

Case presentation: We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction. A literature review was performed to gather information on this rare gastrointestinal tract sarcoma.

Conclusions: Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract. We believe the reporting of all rare or unexpected presentations of sarcoma will eventually improve our understanding of this relatively unusual malignancy.

(A) A spindle cell neoplasm arising from the wall of the small bowel and pushing the mucosa toward the lumen, (B) spindle cells with mild to moderate degree of pleomorphism and few conspicuous nuclei, and (C) a spindle cell metastatic focus in a mesenteric lymph node (hematoxylin and eosin; (A) ×2, (B) ×20, (C) ×4).
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Figure 2: (A) A spindle cell neoplasm arising from the wall of the small bowel and pushing the mucosa toward the lumen, (B) spindle cells with mild to moderate degree of pleomorphism and few conspicuous nuclei, and (C) a spindle cell metastatic focus in a mesenteric lymph node (hematoxylin and eosin; (A) ×2, (B) ×20, (C) ×4).

Mentions: Gross pathology revealed a segment of small bowel measuring 17 × 2 cm. It was adherent to a portion of ascending colon. An 8 × 7 × 3 cm white solid mass with a homogeneous cut surface was bulging from the serosal side of the small bowel; it was 4 cm away from the proximal resection margin. The tumor was adherent to the large bowel but not infiltrating it grossly. Few lymph nodes were identified within the mesenteric fat. Microscopy showed that the tumor was composed of cellular spindle cells with a mild to moderate degree of pleomorphism arising from the small bowel wall and mainly involving the submucosa, muscularis propria and serosa. Focal mucosal erosion was identified. The tumor cells showed a moderate amount of eosinophilic cytoplasm, evenly distributed nuclear chromatin and a few conspicuous nuclei (Figure 2A, B). The mitotic count was one to two per 10 high-power fields. A metastatic focus was identified within a single mesenteric lymph node (Figure 2C).

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Monophasic synovial sarcoma presenting as a primary ileal mass: a case report and review of the literature

Alsharief AN, Fageeh M, Alabdulkarim Y - J Med Case Rep (2012)

(A) A spindle cell neoplasm arising from the wall of the small bowel and pushing the mucosa toward the lumen, (B) spindle cells with mild to moderate degree of pleomorphism and few conspicuous nuclei, and (C) a spindle cell metastatic focus in a mesenteric lymph node (hematoxylin and eosin; (A) ×2, (B) ×20, (C) ×4).
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Figure 2: (A) A spindle cell neoplasm arising from the wall of the small bowel and pushing the mucosa toward the lumen, (B) spindle cells with mild to moderate degree of pleomorphism and few conspicuous nuclei, and (C) a spindle cell metastatic focus in a mesenteric lymph node (hematoxylin and eosin; (A) ×2, (B) ×20, (C) ×4).
Mentions: Gross pathology revealed a segment of small bowel measuring 17 × 2 cm. It was adherent to a portion of ascending colon. An 8 × 7 × 3 cm white solid mass with a homogeneous cut surface was bulging from the serosal side of the small bowel; it was 4 cm away from the proximal resection margin. The tumor was adherent to the large bowel but not infiltrating it grossly. Few lymph nodes were identified within the mesenteric fat. Microscopy showed that the tumor was composed of cellular spindle cells with a mild to moderate degree of pleomorphism arising from the small bowel wall and mainly involving the submucosa, muscularis propria and serosa. Focal mucosal erosion was identified. The tumor cells showed a moderate amount of eosinophilic cytoplasm, evenly distributed nuclear chromatin and a few conspicuous nuclei (Figure 2A, B). The mitotic count was one to two per 10 high-power fields. A metastatic focus was identified within a single mesenteric lymph node (Figure 2C).

Bottom Line: There are few cases reported in other areas.We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction.Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract.

Affiliation: King Fahad Medical City, Riyadh, Saudi Arabia, P,O, Box 59046, Riyadh 11525 Kingdom of Saudi Arabia. Yalabdulkarim@gmail.com.

ABSTRACT

Background:

Introduction: Synovial sarcoma is a rare malignant mesenchymal tumor mainly arising in the peri-articular tissue in young adults. There are few cases reported in other areas.

Case presentation: We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction. A literature review was performed to gather information on this rare gastrointestinal tract sarcoma.

Conclusions: Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract. We believe the reporting of all rare or unexpected presentations of sarcoma will eventually improve our understanding of this relatively unusual malignancy.

View Similar Images In: Results  - Collection
View Article: Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3310833&rFormat=json&query=null&req=5