Aggressive monophasic synovial sarcoma involving sublingual gland: First case
A previously healthy 35-year-old female patient presented with 1½ year history of gradually progressive swelling in the floor of mouth on the left side. She had no difficulty in speech or swallowing. Intraoral examination revealed a smooth swelling of floor of mouth on the left side []. There was no other lymph node palpable in the neck. Results of routine laboratory tests were within the normal limits. Cytological analyses fine-needle aspiration (FNA) of the mass pointed to a mixed salivary tumor-pleomorphic adenoma. Contrast enhanced computed tomography scan showed 3.2 cm × 1.8 cm well-defined homogenously enhancing lesion in the floor of mouth on the left side with no abnormal regional lymph nodes [].\nAt surgery, tumor was well encapsulated with lobulations and enbloc excision along with the capsule was done []. On histopathology, the tumor contained monotonous proliferation of small spindle shaped or ovoid neoplastic cells with pale, eosinophilic cytoplasm []. On immunochemical staining, tumor cells were strongly positive for Mic 2, calponin and focally for cytokeratin (CK), Vimentin and bcl2. They were negative for epithelial membrane antigen ( EMA), S100 protein and HMB45. Final diagnosis of monophasic synovial sarcoma from sublingual gland was made. Patient was advised adjuvant radiotherapy. With only 10# of radiotherapy she developed mucositis and refused any further treatment. On follow-up she developed huge recurrence locally and died of local disease after 6 months.