Soltaninia Omid, Dehghan Arash, Fatehi Faryad, Naderi Hamid
Department of Oral & Maxillofacial Surgery, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Pathology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Int J Surg Case Rep. 2024 Jul;120:109880. doi: 10.1016/j.ijscr.2024.109880. Epub 2024 Jun 11.
Synovial sarcoma is a relatively common high-grade soft-tissue sarcoma. This lesion accounts for 5-10 % of soft-tissue sarcomas, which tend to appear in the limbs, especially the lower limbs. Synovial sarcoma in the neck is rare and causes involvement of the head and neck in 6-7 % of cases. Intraosseous involvement of the mandible is rare. In this report, a rare intraosseous synovial sarcoma of the mandible is reported.
A 29-year-old man with a complaint of painless outgrowth of the gingiva in the posterior region of the left mandible. In the intraoral examination, an exophytic, firm, smooth and well-defined lobulated mass on the alveolar ridge, extending from distal of the second premolar to mesial of the second molar, was observed. On a radiographic examination, a radiolucent lesion with an ill-defined border was seen in the left body of the mandibular with perforation of the buccal cortex. In a histological examination, immunohistochemistry confirmed synovial sarcoma. The patient underwent surgery with wide margins, and radiotherapy after surgery.
The main treatment method is surgery with a wide margin. Radiotherapy as an adjuvant treatment along with surgery is the second most common treatment method. Radiotherapy is recommended in cases of involvement of the margin of the lesion, size greater than 5 cm, and recurrence of the lesion. Chemotherapy after surgery has been used less frequently.
Surgical resection with a wide margin is the main treatment. Adjuvant radiation therapy and chemotherapy can be helpful in tumor control, especially in monophasic cases.
滑膜肉瘤是一种相对常见的高级别软组织肉瘤。该病变占软组织肉瘤的5%-10%，倾向于出现在四肢，尤其是下肢。颈部滑膜肉瘤罕见，在6%-7%的病例中会累及头颈部。下颌骨的骨内受累情况罕见。在本报告中，报道了一例罕见的下颌骨骨内滑膜肉瘤。
一名29岁男性，主诉左下颌骨后部牙龈无痛性肿物。口腔检查时，在牙槽嵴上观察到一个外生性、质地硬、表面光滑且边界清晰的分叶状肿物，从第二前磨牙远中延伸至第二磨牙近中。影像学检查显示，左下颌骨体部有一个边界不清的透射性病变，颊侧皮质有穿孔。组织学检查中，免疫组化确诊为滑膜肉瘤。患者接受了广泛边缘切除手术，并在术后接受了放疗。
主要治疗方法是广泛边缘切除手术。放疗作为手术的辅助治疗是第二常见的治疗方法。在病变边缘受累、大小大于5 cm以及病变复发的情况下，建议进行放疗。术后化疗的使用频率较低。
广泛边缘切除手术是主要治疗方法。辅助放疗和化疗有助于控制肿瘤，尤其是在单相型病例中。
