COMPLETE REMISSION OF SYNOVIAL SARCOMA FOLLOWING NEOADJUVANT CHEMORADIATION

Synovial sarcoma (SS) is a rare but distinctive soft tissue sarcoma (STS) that displays epithelial differentiation. It consists of 5% to 10% of STSs. Surgery is the mainstay of treatment to prevent local recurrence and maximam five-year survival rate is 40 %. Recently, SS was noted to have increased post chemotherapy survival time and the sensitivity of SS to ifosfamide-based chemotherapy has been documented with encouraging results from high-dose ifosfamide therapy. The reported case is a 31 year old man admitted with right shoulder pain and mass from 6 months ago. Primary incisional biopsy reported poorly differentiated synovial sarcoma without any sign of lymphadenopathy or distant metastasis. Due to neurovascular proximity patient referred to an oncologist and received 6 courses Adriamycin, ifo-fosfamide and mesna for 3 weeks. Then he was operated with safe margins and defects covered with thoracoabdominal rotational flap. New pathology report showed necrotic tissues but malignant cells. Then he was treated with post operative radiotherapy and chemotherapy. Amble focused on early diagnosis and the performance of wide surgical removal. Scialabba confirmed survival is associated with small lesions, absence of metastases, and histologically low-grade lesions. Méndez concluded that wide complete surgical resection is mandatory and radiotherapy will only be necessary for uncertain margins, and chemotherapy has not clear benefits as adjuvant therapy in some lesions but its employing is recommended in all cases because of the poor prognosis due to local recurrence. According to available data neoadjuvant chemotherapy can help surgeon in inoperable cases and our patient got neoadjuvant chemotherapy and then underwent the surgery. The report of pathology was amazing because no malignant cell was found in specimen and now we present this case as a curable case of sarcoma.