Synovial sarcoma of the cauda equina

Case report

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Primary synovial sarcoma originating from the cauda equina is extremely rare. Only one case, involving an 11-year-old girl, has been reported. The authors describe the case of a 23-year-old woman with a primary synovial sarcoma of the cauda equina.

The patient visited a local hospital and described a 2-month history of low-back pain. She was referred to the authors' hospital for further evaluation. On physical examination, she had a straight–leg raising result of 70° bilaterally. Motor examination revealed Grade 4/5 strength in the bilateral extensor hallux longus muscles. There was normal sensation to light touch and vibration in the lower extremities. Sagittal Gd-enhanced T1-weighted MR imaging demonstrated an intradural, extramedullary, and uniformly enhancing mass that extended from L-3 to L-4. The mass was totally resected and adjuvant local radiation therapy was administered. Reverse transcriptase polymerase chain reaction (RT-PCR) of a paraffin-embedded tissue sample revealed SYT-SSX fusion transcripts, and the diagnosis of synovial sarcoma was confirmed. Five and a half years after surgery, the patient is free of local recurrence and metastatic disease. The RT-PCR detection of SYT-SSX fusion transcripts played a key role in establishing the diagnosis of synovial sarcoma of the cauda equina. Complete resection of the mass with adjuvant local radiation therapy proved to be effective.

Abbreviations used in this paper: MPNST = malignant peripheral nerve sheath tumor; RT-PCR = reverse transcriptase polymerase chain reaction.

Article Information

Address correspondence to: Ikuho Yonezawa, M.D., Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. email:

Please include this information when citing this paper: published online November 18, 2011; DOI: 10.3171/2011.10.SPINE11359.

© AANS, except where prohibited by US copyright law.



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    Preoperative sagittal Gd-enhanced T1-weighted MR image demonstrating an intradural, extramedullary, and uniformly enhancing mass extending from L-3 to L-4.

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    Photomicrographs. A: Spindle-shaped cells proliferating in a fascicular fashion with stromal hyalinization. H & E, original magnification × 100. B: Pseudorosette formations are focally seen. H & E, original magnification × 100. C: Pseudopapillary structures are frequently seen. H & E, original magnification × 40. D: Distinct expression of S100 protein as seen in MPNSTs is not demonstrated. Original magnification × 100.

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    Upper: A PCR product for SYT-SSX chimeric fusion transcript was detected. contl. = control. Lower: Direct sequencing confirmed that this PCR product contained a sequence identical to that of SYT-SSX1. SYT-SSX1 and SYT-SSX2 sequences are of this amplified region. Characters shown in red indicate different bases between sequences.



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