title: Intraneural synovial sarcoma originating from the median nerve.
abstract: A 33-year-old female presented with a rare synovial sarcoma manifesting as a painful 12 x 15 mm tumor in the median palmar carpus. Preoperative neurological examination detected only radiating spontaneous pain in her right radial palm and decreased right grasping power. Magnetic resonance (MR) imaging confirmed the presence of the tumor. The preoperative diagnosis was schwannoma originating from the right median nerve. Subcapsular removal of the tumor was performed for preservation of the nerve function. However, postoperative histological and immunohistochemical studies suggested synovial sarcoma originating from the median nerve. No systemic metastasis was detected and the residual tumor capsule was totally removed. Local radiation therapy of 40 Gy, 2 Gy per day, was administered. Fourteen months later, local recurrence was detected on MR imaging. Total removal of the recurrent tumor was performed. Synovial sarcoma was finally diagnosed by the identification of SYT-SSX1 fusion gene transcripts using reverse transcriptase-polymerase chain reaction with a frozen tumor tissue sample.
authors.affiliation: Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. huehara@med.miyazaki-u.ac.jp
authors.forename: Hisao
authors.initials: H
authors.lastname: Uehara
authors.forename: Koji
authors.initials: K
authors.lastname: Yamasaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fukushima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamashita
authors.forename: Kosuke
authors.initials: K
authors.lastname: Marutsuka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakano
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Asada
authors.forename: Hideo
authors.initials: H
authors.lastname: Takeshima
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D005260:Female; D006801:Humans; D008475:Median Nerve / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000601:surgery*; D015514:Oncogene Proteins, Fusion / Q000378:metabolism*; D010524:Peripheral Nervous System Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D013584:Sarcoma, Synovial / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D015514:Oncogene Proteins, Fusion; C116512:SYT-SSX fusion protein