A Rare Case of Primary Synovial Sarcoma of Ovary: A Case Report
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CASE REPORT
A Rare Case of Primary Synovial Sarcoma of Ovary: A Case Report Zeeba Usofi1 • T. Subramanyeshwar Rao1 • Rajagopalan Iyer2 • Sudha Murthy3 • R. Ajesh Saksena1 G. Sandhya Devi3
•
Received: 25 May 2020 / Revised: 12 July 2020 / Accepted: 25 July 2020 / Published online: 8 August 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Synovial sarcoma is a malignant neoplasm predominantly of the young age arising from the soft tissues. It does not particularly arise from the synovial membrane and is capable of arising from any tissue. However, it arises most commonly from the para-articular tissue of the extremities. Here, we present a rare case of synovial sarcoma arising from the ovary which mimicked an epithelial ovarian neoplasm on clinical grounds. Our patient is a young 26-year-old unmarried lady who underwent investigations for abdominal pain and lump. She underwent adnexal mass excision, and the histopathology examination noted cells with bizarre nuclei and multinucleation with thick-walled interspersed arborizing vessels. The cells stained positive on IHC for pancytokeratin, CD99 (Figure 4), TLE 1 (Figure 5), FLI-1, CD 34 highlighting vessels and negative for desmin, p16, BCL2. FISH-SYT-SS18 was positive, and FISH-EWSR1 was negative. The pathological features suggested a synovial sarcoma. However, the unusual location of the tumor was worth noting. Although evidence for adjuvant treatment for this is bleak, she was advised adjuvant ifofhamide, but she refused treatment and has relapsed with distant metastasis within 4 months of surgery. Keywords Synovial sarcoma Ovarian neoplasm Case report
Synovial sarcoma is a malignant neoplasm predominantly of the young age arising from the soft tissues. It does not particularly arise from the synovial membrane and is capable of arising from any tissue. However, it arises most commonly from the para-articular tissue of the extremities [1]. Frequently it is the bursae and tendons of the joints that are involved, with the head and neck region being the next most frequent site. Synovial sarcoma has been rarely described in the pelvis [2, 3]. We discuss a case of a 26-year-old unmarried lady who had presented with right-sided abdominal pain and & Zeeba Usofi [email protected] 1
Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Road No. 10, Banjara Hills, Hyderabad, Telangana 500034, India
2
Gynae-Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
3
Department of Pathology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
occasional vomiting of 2-month duration. She underwent abdominal ultrasound which showed a solid cystic right adnexal mass measuring 11.2 9 10.2 cm. The right ovary was not seen separately from the mass. Serum AFP was 1.51 IU/ml, CA19.9 was 182.2 IU/ml, CA125 was 195.7 IU/ml, beta HCG was 0.39mIU/ml, and CEA was 0.47 ng/ml. She underwent further imaging by CT scan of the abdomen,
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