Case presentation
The case study is devoted to investigating headache and left hemiplegia
in a 28-year-old man since 10 days prior to coming to the emergency
room.Neurological examination revealed left sided hemiplegia,without
gait instability and ataxia.Brain computed tomography(CT) scan revealed
an intra axial mass lesion with central necrotic component and
surrounding vasogenic edema in right frontal white matter causing
midline shift to the left side.(FIGURE 1) The patient underwent magnetic
resonance imaging (MRI) with gadolinium contrast for more evaluation,and
the findings were as mentioned bellow:An Intra axial well-circumscribed
heterogenous mass with central necrosis and irregular peripheral
enhancement and significant surrounding vasogenic edema in right frontal
white matter.restriction of peripheral solid component of mass was also
seen.(FIGURE 2)
The patient was taken to the operation room and underwent total excision
of the mass.Many hours later the left hemiplegia was gradually
improved.The histopathological assessment of the mass revealed
neoplastic tissue composed of biphasic pattern: large irregular sheets
of monotonous cells some with central necrosis set in fibroblastic
stroma.Tumoral cells are plump and have very high N/C ratio.Frequent
mitotic figures are present.
IHC staining show positive reactivity for TLE1,FEI1 and INI1 negative
reactivity for Synaptophysin,Olig 2,SMA,CK CD 99.GFAP staining is
nonspecific.Above findings are consistent with Synovial Sarcoma.PET scan
didn’t show any other metastatic disease. Abdominopelvic CT scan was
also normal.
The patient was discharged 1 week after surgery without any neurological
problems.
He underwent radiotherapy 1 month after his discharge.
4 months later,the patient came back to the neurology emergency room
with left hemiplegia,he underwent CT scan findings revealed recurrence
of the previous tumor(FIGURE3) ,so he was taken to operation room again
and underwent total excision of the mass.The histopathological
assessment showed Synovial sarcoma recurrence.PET scan was done again
and there were no evidence of primary synovial sarcoma anywhere else or
any other metastasis.The patient was discharged one week later without
any neurological sign and symptoms.