Arumugam Vasugi Gramani, Sundaram Sandhya, Ramesh Anita, Duvuru Prathiba, Rajappa Srinivasa
Post Graduate, Department of Pathology, Sri Ramachandra Medical College and Research Institute , Chennai, India .
Professor, Department of Pathology, Sri Ramachandra Medical College , Chennai, India .
J Clin Diagn Res. 2016 May;10(5):ED03-5. doi: 10.7860/JCDR/2016/11112.7748. Epub 2016 May 1.
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.
滑膜肉瘤是一种分化较差的恶性软组织肿瘤，常见于四肢的年轻人。我们报告一例50岁女性，右手掌出现软组织肿块。检查时，在鱼际肌旁发现一个单一的质地硬且无压痛的肿胀。影像学检查提示为良性软组织病变。临床上认为该肿胀为脂肪瘤，遂将其切除并送去做组织病理学检查。显微镜检查显示，肿瘤细胞高度密集，呈巢状、条索状和假腺管样排列，被致密的纤维胶原组织分隔。一个有趣且令人困惑的发现是，许多肿瘤细胞中存在明显的黏液空泡。考虑诊断为具有上皮特征的软组织肉瘤，并进行了一组免疫组织化学染色。肿瘤细胞对细胞角蛋白7、波形蛋白、上皮膜抗原和Bcl-2呈强阳性。CD99和S100呈局灶性阳性。CD34和癌胚抗原呈阴性。鉴于上述显微镜检查和免疫组织化学结果，诊断为上皮型单相滑膜肉瘤。记录该病例是因为在单相上皮型滑膜肉瘤中出现黏液空泡这一罕见的形态学表现。
