Clin Endosc.  2012 Nov;45(4):428-430.

Retroperitoneal Synovial Sarcoma Manifested by Obstructive Jaundice in an Elderly Woman: Case Report

• Kim DH
• Joo KR
• Cha JM
• Shin HP
• Lee JI
• Park JJ
• Kim HS
• Yang DM

Abstract

Synovial sarcoma is a rare type of soft tissue sarcoma that arises in tissues containing synovial fluid, usually in the extremities. It has only rare occurrence in the retroperitoneal space. Early detection of retroperitoneal synovial sarcoma is difficult, since the retroperitoneal space is highly expandable and deeply hidden. Furthermore, the presenting symptoms are often vague and nonspecific, and are related to the pressure on adjacent structures. In this study, we present an unusual case of retroperitoneal synovial sarcoma with obstructive jaundice due to intrabiliary blood clots caused by invasion of bile duct by tumor. The obstructive jaundice was relieved through endoscopic removal of the blood clots and insertion of a biliary stent.

Keyword

Sarcoma; Synovial; Retroperitoneal space; Obstructive jaundice

MeSH Terms

Aged
Bile Ducts
Extremities
Humans
Jaundice, Obstructive
Retroperitoneal Space
Sarcoma
Sarcoma, Synovial
Stents
Synovial Fluid

Figure

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  Fig. 1 (A) Axial image of abdomen computed tomography scan revealing the presence of a huge retroperitoneal mass (14×8.5 cm) with direct liver invasion (arrowheads) and compressed inferior vena cava (arrow). (B) Coronal image also reveals encircling of the extrahepatic bile duct by the tumor (arrows).

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  Fig. 2 Magnetic resonance cholangiopancreatography shows the presence of a filling defect (arrow) at the hilar and common hepatic duct level of the bile duct.

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  Fig. 3 Endoscopic retrograde cholangiopancreatography shows a tubular filling defect (arrow); we could verify that the filling defect was movable during the intrabiliary injection of the contrast media. Some fresh blood was discharged from the papillary orifice when contrast media was injected into the bile duct (arrow in the inset).

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  Fig. 4 Microscopic finding of the biopsied specimen reveals the presence of a tumor composed of infiltrating large epithelioid cells with marked nuclear pleomorphism and abundant eosinophilic cytoplasm (H&E stain, ×50). Immunostaining for CD99 shows positive reaction (inset).

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