Synovial sarcoma of the cauda equina

Case report

Ikuho Yonezawa M.D.1, Tsuyoshi Saito M.D., Ph.D.2, Daishi Nakahara M.D.1, JongHwa Won M.D.1, Takuro Wada M.D.3, and Kazuo Kaneko M.D, Ph.D.1
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  • 1 Departments of Orthopaedic Surgery and
  • | 2 Human Pathology, Juntendo University School of Medicine, Tokyo; and
  • | 3 Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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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.

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