title: Biphasic synovial sarcoma in a 19-year-old pregnant woman: a case report.
abstract: Synovial sarcoma is a rare malignant tumor of mesenchymal multipotent cells. We hereby present a case of synovial sarcoma of the upper left thigh. A 19-year-old patient was referred to our clinic by another hospital in Bucharest, Romania, for a soft tissue mass in the left upper thigh. Local examination of the left thigh revealed a 15÷13 cm, ovoid, painful upon touch, soft tissue mass occupying the proximal-medial aspect of the thigh. Bilateral inguinal nodes' enlargement was noticed. Upon suspecting regional node involvement, the surgical team decided to perform left limb amputation due to tumor size and the proximity to major arterial and nervous trunks as well as the femoral shaft, making curative surgery and 'free of disease' resection margins improbable. The patient refused the operation. The surgical team (plastic surgeon, orthopedic surgeon) decided to attempt limb-sparing surgery. After tumor resection, free-of-disease surgical margins were achieved. The pathological examination as well as the immunohistochemistry (IHC) diagnosed a large biphasic synovial sarcoma warranting oncologic treatment. The association between tumor growth and pregnancy poses important therapeutic problems, such as the use of preoperative chemotherapy, potential pregnancy termination, limb amputation versus limb salvage intervention and types of protocols of chemotherapy or radiotherapy indicated.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Bucharest, Romania; madalinaadamesteanu@yahoo.de.
authors.forename: Mădălina Olivia
authors.initials: MO
authors.lastname: Adameşteanu
authors.forename: Răzvan
authors.initials: R
authors.lastname: Scurtu
authors.forename: Ioan
authors.initials: I
authors.lastname: Lascăr
authors.forename: Marek
authors.initials: M
authors.lastname: Vâlcu
authors.forename: Şerban Arghir
authors.initials: ŞA
authors.lastname: Popescu
authors.forename: Ioana Teona
authors.initials: IT
authors.lastname: Sebe
mesh_terms: D000671:Amputation, Surgical; D017024:Chemotherapy, Adjuvant; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis*; D011878:Radiotherapy; D013584:Sarcoma, Synovial / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult