A Tumour in Disguise in the Right Palm- Monophasic Synovial Sarcoma
Published: May 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/.7748
Vasugi Gramani Arumugam, Sandhya Sundaram, Anita Ramesh, Prathiba Duvuru, Srinivasa Rajappa
1. Post Graduate, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, India.
2. Professor, Department of Pathology, Sri Ramachandra Medical College, Chennai, India.
3. Professor, Department of Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India.
4. Professor, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, India.
5. Associate Professor, Department of Orthopedics, Sri Ramachandra Medical College,Chennai, India.
Correspondence
Dr. Sandhya Sundaram,
2A, Abirami Meaddowland, 32 Park Road, Anna Nagar West, Padi, Chennai-600050, India.
E-mail: sandsrid@gmail.com
Synovial sarcoma is one of the poorly differentiated malignant soft tissue tumour occuring commonly among young adults in the extremities. We report a 50-year-old female presenting with a soft tissue mass in the right palm. On examination, a single firm and non tender swelling was noticed adjacent to the thenar muscles. Radiology suggested a benign soft tissue lesion. The swelling, clinically thought to be a lipoma, was excised and sent for histopathological examination. Microscopy showed a highly cellular tumour arranged in nests, cords and pseudo glandular pattern separated by dense fibrocollagenous tissue. An interesting and baffling finding was the presence of a distinct mucin vacuole in many of the tumour cells. A diagnosis of soft tissue sarcoma with epithelial features was considered and a panel of immunohistochemical stains done. Tumour cells showed strong positivity for cytokeratin 7, vimentin, EMA & Bcl2. CD 99 and S100 were focally positive. CD 34 and CEA were negative. In view of the above microscopic and immunohistochemical findings, a diagnosis of monophasic synovial sarcoma of epithelial type was rendered. This case is being documented for the rare morphological appearance of mucin vacuoles in a monophasic epithelial type synovial sarcoma.
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