|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 166-167
Synovial sarcoma of the omentum: A rare entity
G Indranil1, M Divya2
1 Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
2 Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
|Date of Web Publication||5-Feb-2016|
Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Indranil G, Divya M. Synovial sarcoma of the omentum: A rare entity. Indian J Cancer 2015;52:166-7
Synovial sarcoma (SS) is a soft-tissue sarcoma of uncertain origin. SS has rarely been reported in the omentum or other peritoneal structures. We report a case of SS arising from the omentum.
A 16-year-old girl presented with lower abdominal pain for 6 months and recurrent vomiting for 2 months. She was evaluated elsewhere with ultrasound, which revealed a mixed echogenic mass 9.5 cm in diameter, probably arising from the right adnexa. Exploratory laparotomy revealed a fleshy mass attached to greater omentum and a total omentectomy was performed. Histopathology was reported as SS. There was no comment, on size or margins. At this point, she came to our center. Histopathology review showed a malignant spindle cell tumor strongly positive for bcl-2 and SMA with focal positive staining for calretinin, CD117 and EMA and negative for pancytokeratin (AE1/AE3), CK7, CD21, CD23, S100, desmin, CD99 and CD34 [Figure 1]. Features were suggestive of monophasic fibrous SS Grade 3. Translocation X: 18 was identified in the tumor by break-apart fluorescence in situ hybridization assay. Contrast enhanced computed tomography abdomen did not reveal any residual disease. Chest radiograph was normal. She received adjuvant chemotherapy with ifosfamide (1.8 gm/m 2, days 1-5) and adriamycin (25 mg/m 2, days 1-3) every 3 weekly for 4 cycles. Following completion, another computed tomography (CT) scan was also normal. However, 13 months from surgery she developed extensive peritoneal deposits and died shortly thereafter.
|Figure 1: Omental mass. (a and b) Sections show a tumor composed of fascicles of spindle shaped cells with oval to elongated nuclei exhibiting mitotic figures at the rate of 10 to 15/hpf. A mild sprinkling of lymphocytes is present in foci (H and E, ×100 and × 400). (c) Diffuse strong staining for BCL-2 (×400). (d) Focal positive staining for EMA (×400)|
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SS mostly occurs in limbs (80%) while most abdominal tumors arise from retroperitoneum or pelvis. The previously reported cases SS arising from peritoneal structures are summarized in [Table 1].,,,,,, Out of the seven prior published cases, only two were from the omentum. SS may occur in two forms-one is the characteristic biphasic type with both spindle cell (or fibrous) and epithelial components and monophasic type with either of these components (rarely epithelial alone). If cytogenetic confirmation is not feasible, immunohistochemistry may help to establish the diagnosis. Treatment encompasses surgery with wide margins with or without adjuvant radiotherapy and/or chemotherapy. In our case, though the surgical margins were not assessed properly, a total omentectomy had been performed and there was no residual on CT scan. Hence, we did not consider relook surgery. As omentum is not a fixed structure and total omentectomy was carried out, adjuvant radiotherapy was not feasible. Ifosfamide-based chemotherapy was used as it was associated with improved recurrence-free survival in small studies. We want to emphasize that SS can also arise from peritoneal structures and a suggestive morphology, immunohistochemistry and cytogenetic study may help to establish the diagnosis.
|Table 1: Published cases of synovial sarcoma arising from peritoneal structures|
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