title: Synovial sarcoma after chemotherapy for osteosarcoma: a case report.
abstract: A 23-year-old man had eight cycles of adjuvant chemotherapy including doxorubicin, cisplatin, methotrexate, and ifosfamide and radical surgery for biopsy-proved osteosarcoma of the right fibular shaft. Two years after the initial diagnosis, he noticed a mass in the medial aspect of his right knee. Magnetic resonance imaging scans revealed a soft tissue tumor measuring 2 x 2 cm in the pericapsular region of the right knee. Histologically, this soft tissue tumor was composed of spindle cells with occasional atypical mitoses and without matrix formation. Immunohistochemically, the tumor cells were positive for vimentin, cytokeratin, and epithelial membrane antigen, and negative for alpha smooth muscle actin. A fusion gene, SYT-SSX was detected with reverse transcription-polymerase chain reaction. From the results, the secondary tumor was diagnosed as a synovial sarcoma. The current case of double sarcomas is rare. Both sarcomas were diagnosed accurately using immunohistochemical and molecular procedures. This case suggests a positive association between a second tumor and chemotherapy including intraarterial perfusion of doxorubicin.
authors.affiliation: Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan. kudawara@onh.go.jp
authors.forename: Ikuo
authors.initials: I
authors.lastname: Kudawara
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Araki
authors.forename: Akira
authors.initials: A
authors.lastname: Myoui
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Uchida
authors.forename: Haruki
authors.initials: H
authors.lastname: Fukuda
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D005360:Fibula; D006801:Humans; D007719:Knee Joint; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D012516:Osteosarcoma / Q000188:drug therapy*; D013584:Sarcoma, Synovial / Q000175:diagnosis*