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Shirodkar K, Hussein M, Balogh P, Azzopardi C, Botchu R. Painless knee mass in a young adult: answer. Skeletal Radiol 2024:10.1007/s00256-024-04682-8. [PMID: 38642303 DOI: 10.1007/s00256-024-04682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - M Hussein
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - P Balogh
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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2
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He J, Wang J, Yang L, Wang K, Wang M, Li J. Synovial sarcoma of the viscera (lung and jejunum): a case report. J Int Med Res 2024; 52:3000605241233953. [PMID: 38534077 PMCID: PMC10981226 DOI: 10.1177/03000605241233953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/29/2024] [Indexed: 03/28/2024] Open
Abstract
We report the case of a woman nearing 70 years old who was admitted to the hospital with a complaint of "epigastric distension for 1 month". Her main signs and symptoms were progressive abdominal distension and occasional abdominal pain. Computed tomography suggested an abdominal mass. She had a surgical history of synovial sarcoma (SS) of the lungs. After admission, she was diagnosed with jejunal SS following a puncture biopsy and laparoscopic surgery. This disease usually occurs in the soft tissues of the limbs, and it is extremely rare for SS to originate in the jejunum. The morphologic heterogeneity of SS overlaps with other tumors and makes the diagnosis particularly difficult. Imaging studies usually lack specificity; however, measuring multiple immunohistochemical markers can greatly assist in the diagnosis and differential diagnosis of SS. This case not only enriches our understanding of SS and describes a rare site of origin, but also emphasizes the importance and challenges of achieving an accurate diagnosis. Immunohistochemical and molecular biological testing have important roles in the definitive diagnosis, highlighting the need for precise and innovative diagnostic and therapeutic approaches in SS.
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Affiliation(s)
- Jixin He
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Jiwei Wang
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Lina Yang
- Operation Room of the Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Kai Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Maijian Wang
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Jianguo Li
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
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3
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Tabar M, Gultekin MA, Peker AA, Toprak H. An unusual case of retroperitoneal synovial sarcoma with CT, MRI, and F-18 FDG PET/CT findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:89-91. [PMID: 37947310 DOI: 10.1002/jcu.23609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Synovial sarcoma, predominantly found in the extremities, rarely occurs in the retroperitoneum. Tumors can often grow to a considerable size before diagnosis, which warrant the critical importance of early detection to minimize morbidity and mortality. While the final diagnosis relies on pathologic examination, imaging plays a crucial role in early detection.
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Affiliation(s)
- Murat Tabar
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Ali Gultekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Abdusselim Adil Peker
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Huseyın Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel) 2023; 15:4860. [PMID: 37835554 PMCID: PMC10571652 DOI: 10.3390/cancers15194860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15-40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the "triple sign"), in addition to features like hemorrhage and fluid-fluid levels with septa (resulting in the "bowl of grapes" appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2-4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
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Affiliation(s)
- Eun Byul Cho
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yuri Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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5
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Peng Y, Zeng X, Du Y. MRI Manifestations of Primary Intraspinal Synovial Sarcoma: A Case Report. J Belg Soc Radiol 2023; 107:69. [PMID: 37694191 PMCID: PMC10487116 DOI: 10.5334/jbsr.3253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Synovial sarcomas represent a highly malignant form of mesenchymal tumors. The incidence of synovial sarcomas in the spinal canal is exceptionally rare and has been scarcely reported. Teaching Point Comprehending the magnetic resonance imaging manifestations of intraspinal synovial sarcoma is important to prevent misdiagnosis.
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Affiliation(s)
- Yujie Peng
- Affiliated Hospital of North Sichuan Medical College, China
| | - Xiangxin Zeng
- Affiliated Hospital of North Sichuan Medical College, China
| | - Yong Du
- Affiliated Hospital of North Sichuan Medical College, China
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6
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Sedaghat M, Sedaghat S. Primary synovial sarcoma on MRI - a case series and review of the literature. Pol J Radiol 2023; 88:e325-e330. [PMID: 37576379 PMCID: PMC10415809 DOI: 10.5114/pjr.2023.130048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Simple MRI features are mandatory to facilitate the diagnostics of synovial sarcomas, especially for radiolo-gists outside multidisciplinary sarcoma centres. In this case-series and review, we investigate the main appearance of synovial sarcoma on MRI. Material and methods Fifteen histologically proven primary synovial sarcomas who underwent MRI at 2 different sarcoma centres were included in this case series. Patients and their primary synovial sarcomas were examined for age, localization, mean tumour size (in mm), histological grade (G - according to the Fédération Nationale des Centres de Lutte Contre Le Cancer [FNCLCC]), configuration, T2 signal intensity, presence/absence of "triple sign", heterogeneity/homogeneity, borders (well-defined or infiltrative), and intensity of contrast enhancement on MRI. Additionally, a comprehensive literature review to identify observational studies, reviews, and case-reports assessing MRI features of primary synovial sarcoma was performed. Results The mean age of the patients was 47.6 years (SD: 17.2). The mean size of primary synovial sarcoma was 59.3 mm (SD: 42). Primary synovial sarcomas were significantly most often multilobulated (n = 12, p < 0.01), heterogeneous (n = 10), and infiltrative (n = 9). Additionally, 3 other primary synovial sarcomas showed the following configurations: ovoid/nodular (n = 2) and fascicular (n = 1). Ovoid/nodular synovial sarcomas were solely depicted as homogeneous with well-defined borders. All tumours showed T2 hyperintense signal and presented with marked contrast enhancement. Conclusions Primary synovial sarcomas are mainly multilobulated, heterogeneous, and infiltrative tumours. In minor cases, ovoid/nodular or fascicular configurations occur. Knowing the main appearance of synovial sarcoma can help facilitate the diagnostics of primary synovial sarcomas.
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Affiliation(s)
- Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sam Sedaghat
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Almodumeegh AS, Nouri MT, Mortada H, AlHasan MO, Obeid FM, Kattan AE. The potential pitfalls of synovial sarcoma mimicking intraneural ganglion cyst: A case report and literature review. Int J Surg Case Rep 2023; 104:107916. [PMID: 36791526 PMCID: PMC9950915 DOI: 10.1016/j.ijscr.2023.107916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Synovial sarcoma is a rare soft tissue sarcoma (STS) that accounts for 5-10 % of all STS. Synovial sarcoma of the peripheral nerve is very rare, with only 26 cases reported in the literature. Hence, this case report describes an unusual presentation of synovial sarcoma mimicking intraneural ganglion cysts and a literature review. PRESENTATION OF CASE We describe a 36-year-old female who presented to our clinic complaining of left leg pain for six years. MRI was done, which revealed a cystic lesion. With an impression of intraneural ganglion cyst versus nerve sheath tumor of the common peroneal nerve. The patient underwent exploration surgery and mass excision. The mass was sent for histopathology following excision, where the results indicated monophasic synovial sarcoma. An additional surgery, an epineurectomy of the common peroneal nerve and tumor bed excision, was followed by adjuvant chemotherapy with a Doxorubicin-based regimen. Following surgery, our patient's neurological symptoms improved. CLINICAL DISCUSSION The mainstay of treatment in synovial sarcoma is surgical excision with a Doxorubicin-based regimen of chemotherapy and/or radiotherapy based on tumor characteristics. Tumors smaller than 5 cm in MRI usually show homogenous enhancement and can be mistaken for benign tumors. Hence, a biopsy should be done before surgery to avoid misdiagnosis. CONCLUSION Even though it is extremely rare, synovial sarcoma of the lower extremity should be considered when a painful swelling of the lower leg is associated with a long duration of symptoms. Such lesions are best managed by surgical excision and postoperative chemotherapy.
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Affiliation(s)
| | | | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| | | | - Faisal M Obeid
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdullah E Kattan
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Stergioula A, Pantelis E, Kormas T, Agrogiannis G. Case report: skeletal muscle metastasis from follicular thyroid carcinoma presenting as synovial sarcoma. Front Oncol 2023; 13:994729. [PMID: 36845746 PMCID: PMC9950734 DOI: 10.3389/fonc.2023.994729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
Differentiated thyroid carcinomas tend to remain localized and usually are of slow progression with excellent long-term survival. The major sites of distant metastases are cervical lymph nodes, lungs and bones and the minor sites include the brain, liver, pericardium, skin, kidney, pleura and muscle. Skeletal muscle metastases from differentiated thyroid carcinoma, are exceedingly rare. In this report, a 42-year-old woman with follicular thyroid cancer that had had a total thyroidectomy and radioiodine ablation nine years ago was presented with a painful right thigh mass and negative PET/CT scan. The patient had also lung metastases during the follow-up period which were treated with surgery, chemotherapy and radiation therapy. An MRI scan of the right thigh showed a deep-seated lobulated mass with cystic regions, bleeding elements and strong heterogeneous post contrast administration enhancement. Due to the similarities in clinical manifestations and imaging features between soft tissue tumors and skeletal muscle metastases, the case was initially misdiagnosed in favor of synovial sarcoma. Histopathological, immunohistochemistry and molecular analysis of the soft tissue mass confirmed to be a thyroid metastasis and, as a result, a final diagnosis of skeletal muscle metastasis was provided. Even though the probability of a skeletal muscle metastasis from thyroid cancer approaches zero, this study aims to raise the awareness to the medical community that these events do in fact occur in the clinical setting and should be considered in the differential diagnosis of patients with thyroid carcinomas.
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Affiliation(s)
- Anastasia Stergioula
- 1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece,Radiotherapy Department, Iatropolis Clinic, Athens, Greece,*Correspondence: Anastasia Stergioula,
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece,Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Kormas
- Department of Orthopedic Surgery, Saint Savvas Cancer Hospital, Athens, Greece
| | - Georgios Agrogiannis
- 1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Ansari Djafari A, Razzaghi M, Rakhshan A, Faraji S, Rahavian AH, Hojjati SA. A Large Primary Retroperitoneal Synovial Sarcoma: A Case Report of a Huge Malignant Tumor. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:280-284. [PMID: 35634528 PMCID: PMC9126900 DOI: 10.30476/ijms.2021.90470.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
Synovial Sarcoma (SS) is a rare soft-tissue malignancy. Only about 15% of SS originates from the retroperitoneum. Retroperitoneal SS (RSS) is usually diagnosed incidentally due to the anatomy of the retroperitoneum. The most common complaints of patients are abdominal and low back pain. Other common symptoms of RSS are palpable abdominal mass, weight loss, and anemia. In this study, we will describe a 29-year-old white Asian man with a diagnosis of RSS after radical nephrectomy. He was admitted to the Urology Department of Shohada-e Tajrish hospital, Tehran, Iran in March 2019. The distinguishing feature of this case is the size of the mass, which has never been reported so much for retroperitoneal synovial sarcoma. Radiologic imaging showed a huge retroperitoneal mass originating from the kidney. Based on the pathologic features and immunohistochemistry (IHC) study, the diagnosis was consistent with synovial sarcoma. Accurate diagnosis of RSS is usually based on the pathological findings. Therefore, in case of doubt, a biopsy can be employed. Surgical resection of the tumor and lymph nodes dissection is the main and most important part of the treatment. Aggressive resection with free margin is recommended. The role of adjuvant and neoadjuvant chemotherapy in RSS is not certain to date, but it is recommended according to the patient's condition.
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Affiliation(s)
- Anahita Ansari Djafari
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Rakhshan
- Department of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Faraji
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Rahavian
- Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyyed Ali Hojjati
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mishra AK, Raja J, Mittal A, Bansal V. A rare case of synovial sarcoma of diaphragm. Cancer Rep (Hoboken) 2022; 5:e1622. [PMID: 35488382 PMCID: PMC9458493 DOI: 10.1002/cnr2.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/16/2022] [Accepted: 04/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Primary diaphragmatic synovial sarcoma is a rare clinical entity with only few cases reported in the literature. It is found mainly in young adults, in the limbs. However, the name is a misnomer as it probably arises from primitive mesenchyme rather than articular surfaces of the joints. Case We report a case of 21‐year‐old patient with synovial sarcoma of the diaphragm, treated by complete surgical excision of the tumor with diaphragmatic reconstruction and confirmed on immunohistopathology. The peculiarity of this case stems from the atypical location of the tumor with complete surgical resection and thereby providing a better quality of life for the patient. Conclusion Synovial sarcoma of the diaphragm is a rare malignancy and more data and research is needed for defining the best management for this tumor.
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Affiliation(s)
- Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Apeksha Mittal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Farkas AB, Baghdadi S, Arkader A, Nguyen MK, Venkatesh TP, Srinivasan AS, Nguyen JC. Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences. Pediatr Radiol 2021; 51:2539-2548. [PMID: 34322754 DOI: 10.1007/s00247-021-05142-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND While overall survival for children is greater than that for adults, synovial sarcoma remains an aggressive neoplasm with a potentially poor prognosis, and its magnetic resonance imaging (MRI) findings in children are not well described. OBJECTIVE We aimed to characterize the spectrum of MRI findings of synovial sarcoma in children with respect to anatomical location and outcome. MATERIALS AND METHODS Children with histologically confirmed synovial sarcoma and preoperative MRI performed within the past 11 years (2009-2020) were included. Two radiologists retrospectively reviewed each MRI to categorize location, signal characteristics and associated findings. Chi-square and Fisher exact tests were used to assess associations with locations and outcomes. RESULTS This study included 23 children (13 girls, 10 boys; mean age: 12.7±4.2 years) with 7 axial, 8 proximal and 8 distal appendicular lesions. Kappa ranged from 0.53 to 1. MRI findings differed significantly between locations with axial lesions measuring larger (P=0.01) and more likely to contain fluid levels (P=0.02), triple sign (P=0.02), inhomogeneous signal (T1-weighted images, P=0.003; T2-weighted images, P=0.02, contrast-enhanced images, P=0.03) with all lesions containing partially solid composition (P=0.03). At a median follow-up of 14 months (interquartile range: 7-33 months), 39% relapsed. Predictors of relapse (P<0.05) included metastasis at presentation, larger lesions, axial lesions and MRI findings of fluid level, T1-weighted hyperintensity, inhomogeneous signal (T1- and T2-weighted images) and poorly circumscribed margins. CONCLUSION A significant association was found between location and MRI findings in our cohort of children with synovial sarcoma. Axial lesions were more likely to be larger, appear heterogeneous and be associated with a worse outcome.
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Affiliation(s)
- Amy B Farkas
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Soroush Baghdadi
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexandre Arkader
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael K Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Tanvi P Venkatesh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Abhay S Srinivasan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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12
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Zhang G, Fang G, Meng M. Synovial sarcoma of the spinal canal and paraspinal muscle and retroperitoneum: a case with extensive calcification. Childs Nerv Syst 2021; 37:3913-3917. [PMID: 33895870 DOI: 10.1007/s00381-021-05145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Synovial sarcoma (SS) is a rare mesenchymal malignant tumor. SS of the spine or retroperitoneum is an extremely rare site. Approximately 30% cases show focal calcifications on radiographs and computed tomography (CT) images, while extensive calcification rarely occurs. We presented a case of SS involving the spinal canal and paraspinal muscle and retroperitoneum, which showed extensive calcification on CT. CLINICAL PRESENTATION The present report describes the case of a 13-year-old girl suffering from a tumor in the spinal canal and paraspinal muscle and retroperitoneum with extensive calcification on CT. The patient underwent lumbar and retroperitoneal giant tumor resection, lumbar decompression, and spinal tumor resection with a small tumor remnant remaining in the paravertebral region. Histological examination and genetic testing after surgery confirmed synovial sarcoma. After surgery, the patient refused local radiotherapy but agreed to receive chemotherapy. After 4 months of follow-up, her condition was basically stable, and the pain in her left lower limb disappeared. The residual tumor was not increased. CONCLUSION Extensive calcification of SS is rare. The possibility of synovial sarcoma should be considered in those who show extensive calcification in the spinal canal and paraspinal muscle and retroperitoneum on CT. For cases that cannot be completely resected, adjuvant chemotherapy can control the residual tumor in the short term. In addition, the long-term effects need to be observed.
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Affiliation(s)
- Guoping Zhang
- Department of Radiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Guodong Fang
- Department of Pathology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Mingyue Meng
- Department of Radiology, Chengcheng County Hospital, North side of Qingnian Road, Chengcheng, 715200, Shaanxi Province, China.
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Abbas A, Alaa MN. Ewing Sarcoma Family Tumors: Past, Present and Future Prospects. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716999201125204643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ewing’s sarcoma (ES), also known as mesenchymal primitive neuroectodermal tumor
(PNET), is a malignant round blue cell tumor (MRBCT) with a varying degree of neuronal differentiation.
PNET arises from the primitive nerve cells of the central nervous system (CNS) but may
also occur in the bones of the extremities, pelvis, vertebral column, and chest wall. Extraskeletal
ES/PNET may affect the various soft tissues, including those of the pelvis, paraspinal region, and
thoracopulmonary region.
Histopathological differentiation between ES, PNET, and other related sarcomas is often difficult.
On light microscopy, the same histopathological appearance of ES has been termed PNET, Askin-
Rosay (A-R) tumor, and malignant neuroepithelioma by various other authors. The immunohistochemical
distinction is also difficult due to poor tissue differentiation and low intake of the various
specific immunohistochemical markers. The most frequent translocation is t (11; 22) (q24; q12), resulting
in the EWSR1-FLI1 fusion gene detected in nearly 90% of cases and is considered the hallmark
of the diagnosis of ES, PNET, atypical ES, and A-R tumor. Therefore, ES, atypical ES,
PNET, and A-R tumor are currently regarded as one entity grouped together under the Ewing Family
Tumor (EFT) and are treated in an identical way. EFT represents only about 3% of all pediatric
malignancies. The annual incidence is between 2 and 5 cases per million children per year. The
peak prevalence of the tumor is between the ages of 10 and 15 years. The incidence is higher in
males than in females, with a ratio of 1.3:1.
Newer groups of MRBCT that have great similarities to EFT are being recently described. These tumors,
atypical EFT and Ewing’s like Sarcomas (ELS), bear similarities to EFT but have basic morphological
and molecular differences. Optimal treatment requires the use of adjuvant and new-adjuvant
chemotherapy (CTR), radical surgical resection and/or involves field radiotherapy (RT). The
reported disease-free survival (DFS) and overall survival (OS) range between 45-80% and 36-71%,
respectively. The overall prognosis for the metastatic and recurrent disease remains poor. The use
of newer conventional and targeted medications, improved RT delivery, and surgical techniques
may further improve the outcomes. The past few years have seen advances in genomics-based sarcoma
diagnosis and targeted therapies. In this comprehensive review article, we provide a detailed
report of EFT and discuss the various clinical aspects and the recent advances used in the diagnosis
and treatment.
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Affiliation(s)
- Adil Abbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, The Pediatric Hematology/Oncology Setion, Princess Nourah Oncology Centre, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed N.S. Alaa
- Department of Laboratory Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Magnetic resonance imaging of soft tissue sarcoma: features related to prognosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1567-1575. [PMID: 34052920 DOI: 10.1007/s00590-021-03003-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 01/03/2023]
Abstract
Magnetic Resonance Imaging is a fundamental tool in the evaluation of soft tissue sarcoma. Imaging features are relevant for the assessment of treatment strategies, surgical planning and also for patients' prognosis prediction. Among soft tissue sarcoma and also other malignancies, the size of the mass is usually considered the prognostic key element in diagnostic imaging. Moreover, several other features should be obtained from MRI studies with prognostic implications in all type of soft tissue sarcoma: peritumoral enhancement, signs of necrosis, deep location, ill-defined borders/signs of infiltrations. Focusing on soft tissue sarcoma subtypes, some other magnetic resonance imaging features are more specific and related to prognosis. In myxofibrosarcoma the magnetic resonance imaging "tail sign" and a "water-like" appearance on fluid-sensitive sequences, due to rich myxoid matrix content, are both associated with higher risk of local recurrence after surgical excision; nevertheless, the "tail sign" is also related to a higher risk of distant metastases at diagnosis. The "tail sign" is associated with higher risk of local recurrence after surgical excision in undifferentiated pleomorphic sarcoma as well. In patients affected by synovial sarcoma, the "triple sign" identifiable in magnetic resonance imaging (T2w sequences) is associated with decreased disease-free survival and indicates the simultaneous presence of solid cellular elements (intermediate signal intensity), hemorrhage or necrosis (high signal intensity) and fibrotic regions (low signal intensity). In addition, absence of calcifications are associated with reduced disease-free survival in patients affected by synovial sarcoma. Signal heterogeneity is associated with worst prognosis in all type of soft tissue sarcoma, particularly in myxoid liposarcoma. In recent years, several new quantitative tools applied on magnetic resonance imaging have been proved to predict patients' prognosis. Above all the new tools, radiomics seems to be one of the most promising, and, has been proved to have the capability in discriminating low-grade from high-grade soft tissue sarcomas. Therefore, magnetic resonance imaging studies in patients with soft tissue sarcoma should be accurately evaluated and their results should be taken into account for prognostic assessment.
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15
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Synovial Sarcoma: A Clinical Review. ACTA ACUST UNITED AC 2021; 28:1909-1920. [PMID: 34069748 PMCID: PMC8161765 DOI: 10.3390/curroncol28030177] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5–10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.
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16
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Sedaghat S, Ravesh MS, Sedaghat M, Both M, Jansen O. Configuration of soft-tissue sarcoma on MRI correlates with grade of malignancy. Radiol Oncol 2021; 55:158-163. [PMID: 33600679 PMCID: PMC8042815 DOI: 10.2478/raon-2021-0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of the study was to assess whether the configuration of primary soft-tissue sarcoma (STS) on MRI correlates with the grade of malignancy. PATIENTS AND METHODS 71 patients with histologically proven STS were included. Primary STS were examined for configuration, borders, and volume on MRI. The tumors were divided into high-grade (G3), intermediate-grade (G2) and low-grade (G1) STS according to the grading system of the French Federation of Cancer Centers Sarcoma Group (FNCLCC). RESULTS 30 high-grade, 22 intermediate-grade and 19 low-grade primary STS lesions were identified. High- and intermediate-grade (G3/2) STS significantly most often appeared as polycyclic/multilobulated tumors (p < 0.001 and p = 0.002, respectively). Low-grade (G1) STS mainly showed an ovoid/nodular or streaky configuration (p = 0.008), and well-defined borders. The appearance of high-, intermediate- and low-grade STS with an ovoid/nodular configuration were mainly the same on MRI. All streaky G3/2 sarcoma and 17 of 20 patients with polycyclic/multilobulated G3 sarcoma showed infiltrative borders. High-grade streaky and polycyclic/multilobulated STS are larger in volume, compared to intermediate- and low-grade STS. CONCLUSIONS Configuration of STS on MRI can indicate the grade of malignancy. Higher-grade (G2/3) STS most often show a polycyclic/multilobulated configuration, while low-grade STS are mainly ovoid/nodular or streaky. Infiltrative behavior might suggest higher-grade STS in streaky and polycyclic/multilobulated STS.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
| | - Mona Salehi Ravesh
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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17
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MacKay BJ, McCormack RA, Blank AT, Bettiol P, Cox C, Brindley G, Rapp TB. Diagnosis and management of primary malignant tumors in the upper extremity. Orthop Rev (Pavia) 2021; 12:8345. [PMID: 33569156 PMCID: PMC7868949 DOI: 10.4081/or.2020.8345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Bone and soft tissue sarcomas of the upper extremity are relatively uncommon. In many cases, they are discovered incidentally during evaluation of traumatic injuries or common ailments such as rotator cuff tendonitis or tennis elbow. Thus, it is important for all orthopedic surgeons to understand the differential diagnosis, workup, and treatment for upper extremity lesions. An appreciation of the clinical and radiographic features of primary malignant lesions aids in identifying patients that need referral to an orthopedic oncologist and a multidisciplinary team.
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Affiliation(s)
- Brendan J MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX.,University Medical Center, Lubbock, TX
| | | | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Patrick Bettiol
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Cameron Cox
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - George Brindley
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX.,University Medical Center, Lubbock, TX
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18
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Lin N, Liu X, Zhang F, Pan Y, Qi M, Sha Y. Sinonasal synovial sarcoma: evaluation of the role of radiological and clinicopathological features in diagnosis. Clin Radiol 2020; 76:78.e1-78.e8. [PMID: 32896427 DOI: 10.1016/j.crad.2020.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
AIM To explore the value of radiological and clinicopathological features in the diagnosis of sinonasal synovial sarcomas (SS). MATERIALS AND METHODS Six patients with sinonasal SS were studied retrospectively using computed tomography (CT; n=6) and magnetic resonance imaging (MRI; n=4). The radiological and clinicopathological findings in this series were reviewed. RESULTS Three lesions were located, in both the nasal cavity, and the paranasal sinuses; one was located in the nasal cavity and nasopharynx, and the remaining two were located restrictively within the nasal cavity. An aggressive nature (invasion of adjacent structure) was found in four cases. At CT, lesions were found with isodensity with calcification mainly in the peripheral areas. Bony changes were visible in all cases. Five cases showed marked heterogeneous enhancement, and three cases contained necrotic or cystic areas. At MRI, haemorrhage was observed in three cases. All cases demonstrated the "triple sign", and two high-grade SS showed a "cobblestone-like" appearance on T2-weighted imaging (WI). All time-signal intensity curves (TICs) were of the washout type. The mean apparent diffusion coefficient (ADC) values of the two high-grade cases were lower than those of the low-grade or intermediate-grade cases. Histopathologically, all but one was of the monophasic type. During the 8-40 month period of follow-up, recurrence occurred in four cases. CONCLUSIONS A sinonasal tumour exhibiting characteristic calcification and bony change, together with haemorrhage, "triple sign" or "cobblestone-like" appearance, should engender a diagnosis of SS.
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Affiliation(s)
- N Lin
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China
| | - X Liu
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China
| | - F Zhang
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China
| | - Y Pan
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China
| | - M Qi
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China
| | - Y Sha
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai Medical College, Shanghai, 200031, PR China.
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Malhotra A, Jain A, Chhabra A, Arora D, Goel S, Pathak S. Tuberculous involvement of multiple flexor and extensor tendon sheaths of hand and wrist. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_113_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Overview of the clinical and imaging features of the most common non-rhabdomyosarcoma soft-tissue sarcomas. Pediatr Radiol 2019; 49:1524-1533. [PMID: 31620852 DOI: 10.1007/s00247-019-04427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/08/2019] [Accepted: 05/14/2019] [Indexed: 12/15/2022]
Abstract
Non-rhabdomyosarcoma soft-tissue sarcoma (NRSTS) refers to a widely heterogeneous group of extraskeletal mesenchymal neoplasms accounting for approximately 4% of all childhood cancers. This article summarizes the clinical and imaging features of these rare tumors and describes in detail the three most common histological types of NRSTSs encountered in children - synovial sarcoma, malignant peripheral nerve sheath tumor and infantile fibrosarcoma. The author discusses the role of non-cross-sectional and cross-sectional imaging.
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21
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Gao J, Yuan YS, Liu T, Lv HR, Xu HL. Synovial sarcoma in the plantar region: A case report and literature review. World J Clin Cases 2019; 7:2549-2555. [PMID: 31559291 PMCID: PMC6745332 DOI: 10.12998/wjcc.v7.i17.2549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/06/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Synovial sarcoma (SS), a rare malignant soft tissue tumor whose histological origin is still unknown, often occurs in limbs in young people and is easily misdiagnosed.
CASE SUMMARY We report a 24-year-old man who sought treatment for plantar pain thought to be caused by a foot injury that occurred 4 years prior. Currently, he had been seen at another hospital for a 1-wk history of unexplained pain in the left plantar region and was treated with acupuncture, a kind of therapy of Chinese medicine, which partly relieved the pain. Because of this, the final diagnosis of biphasic SS was made after two subsequent treatments by pathological evaluation after the last operation. SS is rarely seen in the plantar area, and his history of a left plantar injury confused the original diagnosis.
CONCLUSION This study shows that pathological and imaging examinations may play a vital role in the early diagnosis and treatment of SS.
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Affiliation(s)
- Jie Gao
- Pingxiang Health Vocational College, Pingxiang Medical School, Pingxiang 337000, Jiangxi Province, China
| | - Yu-Song Yuan
- Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - Ting Liu
- Pingxiang Health Vocational College, Pingxiang Medical School, Pingxiang 337000, Jiangxi Province, China
| | - Hao-Run Lv
- Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
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22
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Dhaduk R, Weber S, Fallat LM. Gouty Tophi in Sinus Tarsi of Bilateral Feet Mimicking Synovial Sarcoma:A Case Report. J Foot Ankle Surg 2019; 58:347-351. [PMID: 30612864 DOI: 10.1053/j.jfas.2018.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 02/03/2023]
Abstract
Chronic gout is defined as accumulation of monosodium urate crystals in joints, cartilage, tendons, bursae, bone, and soft tissue. The foot is the most common location for acute gout flares, with the first metatarsophalangeal joint being the most frequent site of tophus formation. However, few studies have reported gouty tophus formation in the subtalar joint. Gout has been termed the "great mimicker" because of its tendency to mimic other pathologic conditions, such as pigmented villonodular synovitis and synovial sarcoma. Herein, we present a rare case of chronic tophaceous gout in the sinus tarsi in both feet in a 23-year-old healthy male, with extensive bony erosions mimicking pigmented villonodular synovitis and synovial sarcoma. We discuss the clinical presentation, distinguishing radiologic characteristics, surgical procedures, and outcome regarding this unique presentation.
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Affiliation(s)
- Romesh Dhaduk
- Second-Year Surgical Resident, Department of Podiatric Surgery, Beaumont Hospital Wayne, Wayne, MI.
| | - Shane Weber
- Third-Year Radiology Resident, Department of Radiology, Beaumont Hospital Dearborn, Dearborn, MI
| | - Lawrence M Fallat
- Director, Podiatric Surgical Residency, Beaumont Hospital Wayne, Wayne, MI
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23
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Nouh MR, Amr HAEA, Ali RH. Imaging of rare appendicular non-acral soft-tissue chondromas in adults with histopathologic correlation. Acta Radiol 2018; 59:700-708. [PMID: 28906125 DOI: 10.1177/0284185117732100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Soft-tissue chondroma (STC) is a rare benign soft tissue tumor that arises primarily in acral extra-skeletal locations. Occasionally, STCs may arise in more proximal non-acral locations, accompanied by non-classic features that label them as indeterminate lesions and pose diagnostic challenge for both radiologists and pathologists alike. Purpose To explicate the potential of diagnostic imaging in the identification and characterization of appendicular non-acral STCs with emphasis on their morphologic magnetic resonance imaging (MRI) enhancement. Material and Methods Our clinical database records were searched for patients with histologically proven primary soft-tissue chondroid lesions over a five-year period. Two musculoskeletal (MSK) trained radiologists evaluated the imaging studies and an MSK pathologist revised the pathological findings. Results The study included six cases of appendicular non-acral STCs (mean age = 40.5 years). The mean size of the tumors was 5.6 cm, with four localized to the knee region, one in the thigh, and one in the sternoclavicular region. All cases showed high signal intensity matrix with low-signal intensity septa on T2-weighted MRI and post-contrast marginal/septal enhancement. The lesions were lobulated and lacked host tissue reaction except for one showing subjacent mild soft-tissue edema. Histologically, the cases lacked overt features of malignancy although one was originally misdiagnosed as chondrosarcoma. Conclusion Non-acral STCs are benign cartilaginous tumors that may pose a diagnostic challenge, both radiologically and pathologically. Collaborative imaging and pathologic workup is needed for better characterization of non-aggression of these lesions, and to avoid diagnostic pitfalls and unnecessary radical resections.
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Affiliation(s)
- Mohamed Ragab Nouh
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Rola H Ali
- Department of Pathology, Faculty of Medicine, Health Sciences Center, Kuwait University, Safat, Kuwait
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24
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Iwahashi N, Deguchi Y, Horiuchi Y, Ino K, Furukawa K. Omental synovial sarcoma mimicking an ovarian malignancy: A case report. Mol Clin Oncol 2017; 6:688-690. [PMID: 28529743 PMCID: PMC5431683 DOI: 10.3892/mco.2017.1213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/17/2017] [Indexed: 11/17/2022] Open
Abstract
Synovial sarcoma is clinically rare, and cases of synovial sarcoma arising in the omentum are particularly rare. Only 3 cases have been reported in the literature to dtae, and they were associated with a poor prognosis. We herein report a rare case of aggressive primary omental synovial sarcoma presenting as an ovarian malignancy. A 53-year-old multigravida woman was referred to our hospital due to progressive abdominal distension. Magnetic resonance imaging revealed a large heterogeneous mass with an irregular component occupying the lower abdominal cavity, with an intact uterus. Intraoperative examination revealed a solid mass arising from the lower omentum. The diagnosis of omental synovial sarcoma was established based on postoperative pathological and immunohistochemical examination of the tumor. The patient underwent multiple surgical resection procedures due to the development of metastases in the liver, lungs and abdominal cavity and received adjuvant chemotherapy including doxorubicin-ifosfamide, pazopanib and trabectedin. Such rare neoplasms may be difficult to diagnose preoperatively based on radiological examinations alone. Thus, gynecologists should be aware of the possibility of omental synovial sarcoma, and combined surgical and chemotherapeutic interventions are required to control such aggressive tumors.
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Affiliation(s)
- Naoyuki Iwahashi
- Department of Obstetrics and Gynecology, Hashimoto Municipal Hospital, Hashimoto, Wakayama 648-0005, Japan.,Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yoko Deguchi
- Department of Obstetrics and Gynecology, Hashimoto Municipal Hospital, Hashimoto, Wakayama 648-0005, Japan.,Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yuko Horiuchi
- Department of Obstetrics and Gynecology, Hashimoto Municipal Hospital, Hashimoto, Wakayama 648-0005, Japan.,Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Kenichi Furukawa
- Department of Obstetrics and Gynecology, Hashimoto Municipal Hospital, Hashimoto, Wakayama 648-0005, Japan
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25
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Lippert DC, Britt CJ, Pflum ZE, Rush PS, Hartig GK. Metastatic synovial sarcoma of the scalp: Case report. Head Neck 2015; 38:E45-8. [DOI: 10.1002/hed.24122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dylan C. Lippert
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Christopher J. Britt
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Zachary E. Pflum
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
| | - Patrick S. Rush
- Department of Pathology and Laboratory Medicine; University of Wisconsin-Madison; Madison Wisconsin
| | - Gregory K. Hartig
- Department of Otolaryngology; University of Wisconsin-Madison; Madison Wisconsin
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26
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Monophasic Synovial Sarcoma of Prostatic Fascia: Case Report and Literature Review. Case Rep Urol 2015; 2015:419180. [PMID: 26075135 PMCID: PMC4446482 DOI: 10.1155/2015/419180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 11/18/2022] Open
Abstract
Synovial sarcoma (SS) primarily occurs in the para-articular soft tissue of the lower extremities in young adults and it is extremely rare in the prostatic region. We report a case of a 46-year-old man who presented with urinary retention. Pelvic ultrasound (US) examination, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated an 8.5 cm mass that appeared to originate in the prostatic fascia of the right lobe. Preoperative prostatic ultrasound transrectal needle biopsy revealed mesenchymal neoplastic tissue. Patient underwent surgery. The final pathologic findings were consistent with the diagnosis of monophasic synovial sarcoma.
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