Case report: A 27 years old woman with brain metastases of synovial sarcoma

A 27- year old lady with severe headache, nausea, vomiting and impaired cerebellar function. She had a history of a left arm synovial sarcoma and she was evaluated with magnetic resonance imaging (MRI) that shows a gadolinium enhanced mass measuring about 7 mm in diameter with both solid and cystic portions in left cerebellar hemisphere causing mass effect. Histologic evaluation confirmed poorly differentiated type synovial sarcoma composed of tumor cells containing pleomorphic round to oval hyper chromatic to vesicular nuclei with coarse chromatin and a little light eosinophilic cytoplasm. The IHC stain is done and showed EMA, CK and vimentin positivity in tumor cells. The patient was treated with surgery, chemotherapy and radiotherapy. In the follow up study at 6 month post chemotherapy evaluation computed tomography (CT scan) showed pulmonary metastases and transthoracic biopsy revealed the same pathologic feature. According to our patient, brain metastasis could occur even in extremities synovial sarcoma and so CNS imaging as screening may be introduced in follow up plan of these patients.