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Abstract
A 61-year-old male presented with a painful swelling in the right knee lasting for two months. On examination, a tender, tense swelling measuring 4x4 cm around the knee joint was observed. On investigation, complete blood count and peripheral smear were within normal limits. MRI (Magnetic Resonance Imaging) of the knee joints showed a large lobulated mass throughout the knee joint and suprapatellar bursa in the distal thigh, suggestive of a synovial neoplasm. Tc99 MDP whole body scan shows no evidence of osteoblastic metastasis (Fig 3). The clinical diagnosis was synovial sarcoma. Excision biopsy of the mass was performed. Received multiple pieces of grey-tan membraneous tissue, the largest measuring 4x2x1cm (Fig 4). The microscopic examination shows uniform small round blue cells in a vague lobular pattern with scant clear to eosinophilic cytoplasm. (Fig 1)
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References
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- Kim HS, Kim DH, Seo SW, et al. Extraskeletal Ewing's sarcoma in the elderly: a single institution experience. J Orthop Surg Res 2013;8:23.
- Granowetter L, West DC. The Ewing’s sarcoma family of tumors Ewing’s sarcoma and peripheral primitive neuroectodermal tumor of bone and soft tissue. Cancer Treat Res 1997;92:253–308. DOI: https://doi.org/10.1007/978-1-4615-5767-8_9
- Lee JA, Kim DH, Lim JS, et al. Soft-tissue Ewing sarcoma in a low-incidence population: comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010;40(11):1060-7. DOI: https://doi.org/10.1093/jjco/hyq080
- El Weshi A, Allam A, Ajarim D, et al. Extraskeletal Ewing’s sarcoma family of tumours in adults: analysis of 57 patients from a single institution. Clin Oncol 2010;22(5):374-81. DOI: https://doi.org/10.1016/j.clon.2010.02.010
- Lin PP, Jaffe N, Herzog CE, et al. Chemotherapy response is an important predictor of local recurrence in Ewing sarcoma. Cancer 2007;109(3):603-11. DOI: https://doi.org/10.1002/cncr.22412
- Kaneko Y, Yoshida K, Handa M, et al. Clinical significance of minimal disseminated disease in bone marrow and peripheral blood in pediatric patients with Ewing sarcoma. Cancer 2002;94(11):3370-7.
References
Grier HE. The Ewing family of tumors. Ewing's sarcoma and primitive neuroectodermal tumors. Pediatr Clin North Am 1997;44(5):991-1004. DOI: https://doi.org/10.1016/S0031-3955(05)70541-1
Bernstein M, Kovar H, Paulussen M, et al. Ewing's sarcoma family of tumors: current management. Oncologist 2006;11(8):503-19. DOI: https://doi.org/10.1634/theoncologist.11-5-503
Yoshida A, Sekine S, Tsuta K, et al. NKX2.2 is a useful immunohistochemical marker for Ewing sarcoma. Am J Surg Pathol 2012;36(7):993-9. DOI: https://doi.org/10.1097/PAS.0b013e31824ee43c
Folpe AL, Goldblum JR, Rubin BP, et al. Morphologic and immunophenotypic diversity in Ewing family tumors: a study of 66 genetically confirmed cases. Am J Surg Pathol 2005;29(2):1025-33. DOI: https://doi.org/10.1097/01.pas.0000167056.13614.62
Kim HS, Kim DH, Seo SW, et al. Extraskeletal Ewing's sarcoma in the elderly: a single institution experience. J Orthop Surg Res 2013;8:23.
Granowetter L, West DC. The Ewing’s sarcoma family of tumors Ewing’s sarcoma and peripheral primitive neuroectodermal tumor of bone and soft tissue. Cancer Treat Res 1997;92:253–308. DOI: https://doi.org/10.1007/978-1-4615-5767-8_9
Lee JA, Kim DH, Lim JS, et al. Soft-tissue Ewing sarcoma in a low-incidence population: comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010;40(11):1060-7. DOI: https://doi.org/10.1093/jjco/hyq080
El Weshi A, Allam A, Ajarim D, et al. Extraskeletal Ewing’s sarcoma family of tumours in adults: analysis of 57 patients from a single institution. Clin Oncol 2010;22(5):374-81. DOI: https://doi.org/10.1016/j.clon.2010.02.010
Lin PP, Jaffe N, Herzog CE, et al. Chemotherapy response is an important predictor of local recurrence in Ewing sarcoma. Cancer 2007;109(3):603-11. DOI: https://doi.org/10.1002/cncr.22412
Kaneko Y, Yoshida K, Handa M, et al. Clinical significance of minimal disseminated disease in bone marrow and peripheral blood in pediatric patients with Ewing sarcoma. Cancer 2002;94(11):3370-7.