A case report of pancreatic metastasis from synovial sarcoma successfully treated by metastasectomy with adjuvant chemotherapy.
BACKGROUND
Synovial sarcoma is a malignant soft tissue sarcoma which arises near joints. The most frequent metastasis sites of synovial sarcoma are the lungs, lymph nodes, and bone. Pancreatic metastasis is quite rare; only 3 cases have been reported worldwide to date. We herein present the 4th case of pancreatic metastasis from synovial sarcoma.


RESULTS
A 32-year-old man underwent extended excision of synovial sarcoma in the left pelvis and femur in 2009. In 2013, follow-up contrast-enhanced computed tomography revealed a 35-mm heterogeneously enhanced mass in the pancreas body. Endoscopic ultrasound-guided fine needle aspiration of the mass revealed a diffuse proliferation of atypical spindle cells in a fascicular arrangement. Because the histology was quite similar to the resected specimen of synovial sarcoma in 2009, the mass was suspected to be a metastasis from synovial sarcoma. Laparoscopic distal pancreatectomy with adjuvant adriamycin/ifosfamide chemotherapy was subsequently performed. Synovial sarcoma-specific SS18-SSX1 (synovial sarcoma translocation, chromosome 18-synovial sarcoma X1) or SS18-SSX2 chimera mRNA was detected in the resected specimen, confirming the diagnosis of metastasis from synovial sarcoma. The patient did well for 30 months without recurrence.


CONCLUSIONS
This case suggests that pancreatic metastasis from synovial sarcoma can be successfully treated by metastasectomy with adjuvant chemotherapy.
aDepartment of Gastroenterology and Hepatology bDepartment of Gastroenterological Surgery cDepartment of Orthopaedic Surgery, Osaka University Graduate School of Medicine dMusculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases eDepartment of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan.
Yuki
Y
Makino
Minoru
M
Shigekawa
Tadashi
T
Kegasawa
Takahiro
T
Suda
Teppei
T
Yoshioka
Kiyoshi
K
Iwahashi
Kenji
K
Ikezawa
Ryotaro
R
Sakamori
Takayuki
T
Yakushijin
Jun
J
Kajihara
Yoshito
Y
Tomimaru
Hidetoshi
H
Eguchi
Yoshinori
Y
Imura
Hidetatsu
H
Outani
Norifumi
N
Naka
Keiichiro
K
Honma
Eiichi
E
Morii
Tomohide
T
Tatsumi
Naoki
N
Hiramatsu
Tetsuo
T
Takehara
D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D013584:Sarcoma, Synovial / Q000473:pathology*
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