Synovial Sarcoma




CLINICAL SUMMARY


Synovial sarcoma is the fourth or fifth most common subtype of soft tissue sarcoma and is distinguished by its younger age of presentation, frequent history of pain, and diagnostic chromosomal translocation. While the need for surgical wide resection and optional radiotherapy is analogous to that in other soft tissue sarcomas, the use of chemotherapy for large, deep synovial sarcomas appears to be more clearly associated with improved survival.




DIAGNOSTIC FEATURES


















History


  • Average age: 35 years



  • In contrast to other soft tissue sarcomas, often presents as a painful mass



  • Symptoms can persist for years before diagnosis

Location


  • Approximately 60% are in the lower extremity



  • The most common is soft tissue sarcoma of the foot

MRI


  • Small masses have nonspecific appearance with low signal on T1, high signal on T2



  • Larger masses may demonstrate hemorrhagic cysts, represented as fluid levels on MRI



  • Radiographs sometimes show faint calcification






IMAGING
























  • Synovial sarcoma in the proximal forearm shows radiographically visible calcification ( left ). This is found in up to 30% of these tumors.



  • Extrinsic bone erosion of the second metatarsal and cortical thickening of the third metatarsal is seen in this foot tumor ( right ). Periosteal reaction is seen in 11% to 20% of synovial sarcomas, and cortical erosion in 5%.


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