Radiation-associated Synovial Sarcoma Arising in the Digestive Tract: A Case Report and Literature Review
Synovial sarcoma of the digestive tract is an extremely rare tumor. Only 12 cases were reported; none of these was in the gastroduodenal region. Radiation therapy is well known for its long-term carcinogenesis, especially of soft tissue sarcomas. Only four cases of radiation-associated synovial sarcoma have been reported. We report a case of primary gastroduodenal synovial sarcoma in a 54-year-old woman who was treated for Hodgkin’s lymphoma at age 35, using external radiation to the mantle field and the paraortic strip (including abdominal paraaortic nodes). She presented with epigastric pain and sensation of fullness, associated with loss of appetite and weight. An upper endoscopy showed a distal gastric mass extending to the post-pulpal duodenum; a tissue biopsy of the mass showed monophasic synovial sarcoma with positive epithelial membrane antigen (EMA). The diagnosis was confirmed when reverse transcriptase-polymerase chain reaction (RT-PCR) demonstrated the presence of a SYT-SSX fusion transcript. She underwent total duodenectomy and partial gastrectomy and gastrojejunostomy. After surgery she regained her appetite and started gaining weight. She has been symptom-free for 7 months after the surgery.
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