Primary synovial sarcoma of thyroid gland: A case report and review of literature

Abstract

Introduction and importance Synovial cell sarcoma (SS) is an extremely rare mesenchymal malignancy, representing nearly 10% of all soft-tissue sarcomas. These high-grade soft tissue sarcomas commonly arise in the para-articular regions of lower extremities. However, 15% of Synovial sarcomas has been described at Unusual locations, including head, neck, and trunk. Herein, we describe the twelfth case of primary synovial cell sarcoma of thyroid with a literature review. Case presentation A 43-year-old woman presented with complaint of a progressive neck mass for the last five-months. She developed with dysphagia and dyspnea nearly 2 months prior, without signs of hoarseness, and weight loss. Ultrasonography in which revealed a heterogeneous, hypervascularized thyroid mass. After total thyroidectomy immunohistochemistry was in favor of primary synovial cell sarcoma of thyroid. The diagnosis was confirmed via Molecular genetic analysis of the SYT-SSX fusion gene transcript using the RT- polymerase chain reaction method. Clinical Discussion: Primary thyroid SVS is an extremely rare malignancy with poor biological behavior. SVS has been known for its tendency to local and distal re-occurrence after a few years of treatment. SS can be classified into two subtypes of monophasic or biphasic based on the presence of mesenchymal and/or epithelial components. Accordingly, the most accurate diagnostic tool for SS is considered to be molecular genetic analysis for SYT/SSX fusion transcript. Conclusion Herein, we reported an extremely rare case of SVS of thyroid gland. These high-grade soft tissue sarcomas mainly present with an asymptomatic rapid growing neck mass. Unspecific clinical presentations and extreme rarity of this disorder, make the diagnosis of thyroid SVS very challenging. Due to paucity of data, there is not enough evidence to establish a reliable mortality rate. However, the prognosis of thyroid SVS seems unfavorable.

Diagnostic difficulties in evaluation of primary malignant lesions of thyroid: A study of cytomorphology, histopathology, and immunohistochemistry

“…SS is an exceedingly rare malignant mesenchymal neoplasm accounting for about 10% of soft-tissue sarcomas. [ 1 ] These are an extremely rare, malignant group of tumors characterized by chromosomal translocation t(X;18)(p11.2;q11.2) which results in the expression of SYT-SSX gene transcript. [ 2 ] SS is thought to arise from multipotent stem cells and not synovium.…”

“…To the best of our knowledge, only 13 cases have been reported in the literature so far. [ 1 ] It commonly presents in young adults and adolescents [ 1 , 6 ] and men are affected more than women with a 2:1 sex ratio. [ 1 ] The presenting symptoms usually include an asymptomatic rapidly growing neck mass.…”

“…[ 1 ] It commonly presents in young adults and adolescents [ 1 , 6 ] and men are affected more than women with a 2:1 sex ratio. [ 1 ] The presenting symptoms usually include an asymptomatic rapidly growing neck mass. [ 1 ] The symptoms may also include hoarseness, dysphagia, dysphonia, and excessive salivation which may all be a result of compression effects by a rapidly growing tumor.…”

“…[ 1 ] The presenting symptoms usually include an asymptomatic rapidly growing neck mass. [ 1 ] The symptoms may also include hoarseness, dysphagia, dysphonia, and excessive salivation which may all be a result of compression effects by a rapidly growing tumor. [ 1 ] This unusual location makes the diagnosis of SS difficult.…”

Efficacy of Tranexamic Acid in the Treatment of Massive Upper Gastrointestinal Bleeding: A Randomized Clinical Trial

“…Peptic ulcer disease, followed by esophageal varices, and malignancies are considered the most common causes of GIB, which if severe, presents with hematemesis, melena, and hemodynamic instability [ 3 , 4 ]. Acute management of choice for patients suffering from GIB includes medical and endoscopic therapy, blood transfusion, and surgery [ 5 , 6 ]. Early blood transfusion is considered lifesaving among patients with rapid blood loss, and significant comorbidities, including coronary artery disease, brain injury, and any other medical condition that predispose patients to ischemic damage.…”