The role of immunohistochemistry in the diagnosis and management of synovial sarcoma.

Synovial sarcoma (SS) is a malignant soft tissue tumor representing 5-10% of all soft tissue sarcomas. Most synovial sarcomas are found at the extremities, especially in the lower limbs. A 28-year-old female presented at the Department of Plastic and Reconstructive Surgery, "Dr. Pius Brînzeu" Clinical Hospital, Timisoara, Romania, for evaluation of a mass located in the anterior region of the elbow. Imagistic, histological and immunohistochemically evaluations established the diagnosis of monophasic spindle cell SS G2. Block excision of the tumor with oncological safety margins was performed followed by total elbow arthroplasty. The patient then received radio- and chemotherapy. The case was followed-up at regular intervals for local recurrence and metastases and was free of symptoms at two years. Early diagnosis of SS, multimodal therapies and performing an arthroplasty of the elbow allowed the patient to resume daily activities. The unpredictable evolution requires regular follow-up for a long period of time.

Alveolar rhabdomyosarcoma in an adolescent male patient - case report and current perspectives.

Alveolar rhabdomyosarcoma (RMS) is a common pediatric malignant mesenchymal tumor, representing half of soft tissue sarcomas and approximately 5% of all cancers. We present the case of an adolescent male patient treated in our Department for a tumoral mass located in the middle third of the forearm. Magnetic resonance imaging (MRI) and angiography-computed tomography (angio-CT) showed a large mass located in the muscles of the anterior compartment of the forearm. Surgical treatment consisted of tumor ablation including segmental resection of the radial and ulnar arteries and of the median nerve, followed by saphenous autograft vascular bypass. The treatment plan was based on tumor type, histological grading (high), age, tumor size greater than 5 cm, unfavorable location, postoperative tumor, node, metastasis (TNM) stage II, presence of microscopic tumoral tissue in the margins of the resected piece, lymph node metastases (N1) and bone metastases (M1) found on positron-emission tomography (PET)-CT according to the German soft tissue sarcoma study (CWS)-IV 2002 protocol. The chemotherapy used Carboplatin and Topotecan. Survival was less than two years after the initial presentation. Adolescent extremity masses should raise suspicion to exclude serious malignancy. Despite early diagnosis and use of multimodal therapies, alveolar RMS prognostic remains unpredictable.

Conventional chondrosarcoma in the right hand with the invasion of the pisiform and the hamate bones - case report.

Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in two forms: primary, representing 90% of all cases and secondary emergence that develops on preexistent lesions. Primary chondrosarcomas are uncommon in the hand, with a frequency of only 1.5-3.2% of all chondrosarcomas. In conventional chondrosarcoma (cCS), the histological malignancy grading represents the main prognostic factor for surgical planning and prognosis. We present the case of a 60-year-old male, examined in the First Department of Orthopedics and Traumatology, "Dr. Pius Branzeu" Clinical Hospital, Timisoara, Romania, with non-specific symptoms in the right hand. After clinical examination and imagistics, surgery and histopathological examination of the tumor were performed. This showed a conventional well differentiated - G1 chondrosarcoma, as suggested also by imagistic and clinical context.