Sarcoma Sinovial Fibroso Do Pé: Relato De Caso

Abstract

Os autores relatam o caso de uma paciente de 24 anos de idade, que apresentou dor e aumento do volume do hálux esquerdo há três meses. A ultra-sonografia mostrou massa sólida, hipoecóide, heterogênea, com áreas císticas e calcificação, no dorso do hálux esquerdo, em partes moles, com estrutura tendínea no seu interior, sem aparente comprometimento de estruturas ósseas. O estudo com Doppler colorido mostrou hipervascularização central e periférica na lesão. A ressonância magnética evidenciou massa sólida, de partes moles, com estrutura tendínea no seu interior, com médio sinal em T1 e alto sinal em T2, com realce intenso e heterogêneo pelo meio de contraste paramagnético, sem acometimento de estruturas ósseas. A paciente foi submetida a procedimento cirúrgico, com ressecção da lesão descrita, no dorso do hálux esquerdo, e o exame anatomopatológico demonstrou tratar-se de sarcoma sinovial fibroso monofásico.

Poorly differentiated synovial sarcoma in the wrist - Case report

“…For this reason, early treatment has an important impact on life expectancy. 1 , 2 , 4 They are located in deep soft tissues, close to the joints, especially in the lower limbs, being rarely located in the wrist. 1 , 2 , 3 In initial stages the tumor is well defined, but gradually infiltrates adjacent structures and/or involves more remote sites like the lungs (80%) and lymph nodes (20%) by metastasis.…”

“…1 , 2 , 4 They are located in deep soft tissues, close to the joints, especially in the lower limbs, being rarely located in the wrist. 1 , 2 , 3 In initial stages the tumor is well defined, but gradually infiltrates adjacent structures and/or involves more remote sites like the lungs (80%) and lymph nodes (20%) by metastasis. 2 , 3 The diagnosis depends on histopathological study that can identify 4 subtypes: biphasic, monophasic epithelial, monophasic fibrous and the poorly defined SS.…”

“…1 , 2 , 3 In initial stages the tumor is well defined, but gradually infiltrates adjacent structures and/or involves more remote sites like the lungs (80%) and lymph nodes (20%) by metastasis. 2 , 3 The diagnosis depends on histopathological study that can identify 4 subtypes: biphasic, monophasic epithelial, monophasic fibrous and the poorly defined SS. Many times the histology of these tumors looks like metastatic carcinoma, malignant melanoma, epithelioid sarcoma and malignant schwannoma raising the need of immunohistochemistry for differential diagnosis.…”

“…Many times the histology of these tumors looks like metastatic carcinoma, malignant melanoma, epithelioid sarcoma and malignant schwannoma raising the need of immunohistochemistry for differential diagnosis. 1 , 2 Almost all SS are positive for vimentin, cytokeratin EMA and TLEI (Wnt pathway, synovial sarcoma). In the poorly differentiated form the focal marker of EMA and TLEI on neoplastic cells is more frequent than that of cytokeratins, which is usually negative, confirming the immuno-histochemical panel finding of the report.…”

“…Synovial sarcomas (SS) are rare benign neoplasms that encompass from 5 to 10% of soft tissue sarcomas. 1 , 2 They affect mainly young adults and present as a painful slow growth mass located in deep soft tissues of extremities, near joints, even though their onset can be in any part of the body. Primary involvement of the epidermis in these sarcomas is extremely rare.…”