Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
BMC Surg. 2020 Aug 5;20(1):175. doi: 10.1186/s12893-020-00832-6.
Synovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy.
A 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery.
While the rate of tumor growth varies depending on the grade of the tumor, the possibility of rupture should be considered even in metastatic pancreatic tumors. In the case of pancreatic tumor rupture with stable circulation, radiological evaluation for oncology is necessary, and primary resection may be compatible with resectable cases.
滑膜肉瘤是一种软组织恶性肿瘤，常发生于四肢，靠近大关节。滑膜肉瘤远处转移率高；然而，胰腺转移极为罕见，据我们所知，尚无因自发性肿瘤破裂导致出血的报道。本研究报告了一例滑膜肉瘤胰腺转移导致肿瘤破裂出血的病例，通过紧急胰尾切除术成功治疗。
一名 27 岁女性，4 年前因左股骨滑膜肉瘤和多发性肺转移接受了广泛的肿瘤切除和部分肺叶切除术，化疗后，在腹部 CT 检查中发现胰腺尾部有一个 35mm 的肿瘤，正电子发射断层扫描 CT 未发现其他远处转移。计划行腹腔镜胰尾切除术治疗滑膜肉瘤胰腺转移。然而，在预定的胰切除术之前，患者因饮酒后出现腹痛而就诊于急诊，CT 显示腹水 CT 值高且有造影剂漏出。诊断为转移性胰腺肿瘤破裂引起的腹腔内出血，并进行了紧急手术。共从腹部抽出 1500ml 血液，切除了出血的胰尾肿瘤。组织病理学检查结果显示为滑膜肉瘤转移和破裂的肿瘤包膜，血肿中观察到肿瘤细胞。术后第 18 天出院，患者在术后 6 个月无化疗，无复发，无化疗，处于无复发生存状态。
尽管肿瘤生长速度取决于肿瘤分级，但即使是转移性胰腺肿瘤也应考虑破裂的可能性。对于循环稳定的胰腺肿瘤破裂，有必要进行肿瘤学的影像学评估，对于可切除的病例，原发切除可能是可行的。
