Synovial sarcoma: Difference between revisions
Jump to navigation
Jump to search
Mahshid |
No edit summary |
||
| Line 7: | Line 7: | ||
==Overview== | ==Overview== | ||
Synovial sarcoma (also known as [[malignant]] synovioma) is a very rare form of [[soft tissue]] [[sarcoma]], which usually occurs near the [[Joint|joints]] in upper and lower [[Limb (anatomy)|extremities]]. Synovial sarcoma was first discovered by Pack and Tabah in 1955. Synovial sarcoma may be classified according to histopathological findings into 4 subtypes: biphasic, monophasic fibrous (most common), monophasic epithelial, and poorly differentiated. The pathogenesis of synovial sarcoma is characterized by the dysregulation of gene expression of SYT-SSX gene. The most common location for these synovial sarcoma, include: | |||
[[knee]], adjacent to large joints, and [[popliteal fossa]].<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> The SYT-SSX fusion gene (located in [[chromosome 18]]) has been associated with the development of synovial sarcoma. Synovial sarcomas account for 2.5-10% of all soft tissue sarcoma, and it is more commonly observed among adolescents and young adults. The diagnosis of synovial sarcoma is typically made based on histology and is confirmed by the presence of t(X;18).<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> MRI is the imaging modality of choice for synovial sarcoma. Surgical resection in conjunction with chemotherapy or radiation is the most common approach to the treatment of synovial sarcoma.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | [[knee]], adjacent to large joints, and [[popliteal fossa]].<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> The SYT-SSX fusion gene (located in [[chromosome 18]]) has been associated with the development of synovial sarcoma. Synovial sarcomas account for 2.5-10% of all soft tissue sarcoma, and it is more commonly observed among adolescents and young adults. The diagnosis of synovial sarcoma is typically made based on histology and is confirmed by the presence of t(X;18).<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> MRI is the imaging modality of choice for synovial sarcoma. Surgical resection in conjunction with chemotherapy or radiation is the most common approach to the treatment of synovial sarcoma.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
| Line 14: | Line 14: | ||
==Classification== | ==Classification== | ||
*Synovial sarcoma may be classified according to histopathological findings into 4 | *Synovial sarcoma may be [[Classification|classified]] according to [[Histopathology|histopathological]] findings into 4 sub-types:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
:*Biphasic | :*Biphasic | ||
:*Monophasic fibrous (most common) | :*Monophasic [[fibrous]] (most common) | ||
:*Monophasic epithelial | :*Monophasic [[Epithelium|epithelial]] | ||
:*Poorly differentiated | :*Poorly differentiated | ||
==Pathophysiology== | ==Pathophysiology== | ||
*The pathogenesis of synovial sarcoma is characterized by the dysregulation of gene expression of SYT-SSX gene.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | *The [[pathogenesis]] of synovial sarcoma is characterized by the dysregulation of [[gene expression]] of SYT-SSX [[gene]].<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
*The most common | *The most common locations for the occurrence of synovial sarcoma include:<ref name="pmid19865558">{{cite journal |vauthors=Gomatos IP, Alevizos L, Kafiri G, Bramis J, Leandros E |title=Management of a small incidentally discovered retroperitoneal synovial sarcoma |journal=Can J Surg |volume=52 |issue=5 |pages=E199–200 |year=2009 |pmid=19865558 |pmc=2769101 |doi= |url=}}</ref> | ||
:*[[Knee]] | :*[[Knee]] | ||
:*Adjacent to large joints | :*Adjacent to large [[Joint|joints]] | ||
:*[[Popliteal fossa]] | :*[[Popliteal fossa]] | ||
*The SYT-SSX fusion gene (located in chromosome 18) has been associated with the development of synovial sarcoma. | *The SYT-SSX fusion [[gene]] (located in [[chromosome]] 18) has been associated with the development of synovial sarcoma. | ||
*On gross pathology, characteristic findings of synovial sarcoma | *On [[gross pathology]], characteristic findings of synovial sarcoma include: | ||
:*Solid often lobulated | :*Solid often [[Lobule|lobulated]] | ||
:*Grey-yellow | :*Grey-yellow | ||
:*Pushing border to ill-defined border | :*Pushing border to ill-defined border | ||
*On microscopic histopathological analysis, characteristic findings of synovial sarcoma | *On [[microscopic]] [[Histopathology|histopathological]] [[analysis]], characteristic findings of synovial sarcoma include:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
:*Non-specific appearances | :*Non-specific appearances | ||
:*Well or poorly defined heterogeneous masses | :*Well or poorly defined [[heterogeneous]] masses | ||
:*Frequent areas of hemorrhage | :*Frequent areas of [[Bleeding|hemorrhage]] | ||
:*Necrosis | :*[[Necrosis]] | ||
==Causes== | ==Causes== | ||
| Line 41: | Line 41: | ||
==Differentiating Synovial Sarcoma from Other Diseases== | ==Differentiating Synovial Sarcoma from Other Diseases== | ||
*Synovial sarcoma must be differentiated from other diseases that cause joint pain, mass growth, and limited range of motion, such as:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | *Synovial sarcoma must be differentiated from other [[Disease|diseases]] that cause [[Arthralgia|joint pain]], mass growth, and limited [[range of motion]], such as:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
:*[[Malignant fibrous histiocytoma | :*[[Malignant fibrous histiocytoma|Malignant fibrous histiocytoma (MFH)]]-[[fibrosarcoma]] | ||
:*[[Liposarcoma]] | :*[[Liposarcoma]] | ||
:*[[Osteosarcoma]] | :*[[Osteosarcoma]] | ||
| Line 48: | Line 48: | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The prevalence of synovial sarcoma remains unknown.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | * The [[prevalence]] of synovial sarcoma remains unknown.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
* Synovial sarcomas account for 2.5-10% of all soft tissue | * Synovial sarcomas account for 2.5 - 10% of all [[soft tissue]] sarcomas. | ||
===Age=== | ===Age=== | ||
*Synovial sarcoma is more commonly observed among patients aged 15-40 years old. | *Synovial sarcoma is more commonly observed among [[Patient|patients]] aged 15 - 40 years old. | ||
*Synovial sarcoma is more commonly observed among adolescents and young adults. | *Synovial sarcoma is more commonly observed among [[Adolescence|adolescents]] and young [[Adult|adults]]. | ||
===Gender=== | ===Gender=== | ||
* Males are more commonly affected with synovial sarcoma than females | * [[Male|Males]] are more commonly affected with synovial sarcoma than [[Female|females]]. | ||
* The male to female ratio is approximately 1.2 to 1. | * The [[male]] to [[female]] ratio is approximately 1.2 to 1. | ||
===Race=== | ===Race=== | ||
| Line 62: | Line 62: | ||
==Risk Factors== | ==Risk Factors== | ||
*There are no known risk factors associated with the development of synovial sarcoma.<ref name="pmid19865558">{{cite journal |vauthors=Gomatos IP, Alevizos L, Kafiri G, Bramis J, Leandros E |title=Management of a small incidentally discovered retroperitoneal synovial sarcoma |journal=Can J Surg |volume=52 |issue=5 |pages=E199–200 |year=2009 |pmid=19865558 |pmc=2769101 |doi= |url=}}</ref> | *There are no known [[Risk factor|risk factors]] associated with the development of synovial sarcoma.<ref name="pmid19865558">{{cite journal |vauthors=Gomatos IP, Alevizos L, Kafiri G, Bramis J, Leandros E |title=Management of a small incidentally discovered retroperitoneal synovial sarcoma |journal=Can J Surg |volume=52 |issue=5 |pages=E199–200 |year=2009 |pmid=19865558 |pmc=2769101 |doi= |url=}}</ref> | ||
== Natural History, Complications and Prognosis== | == Screening == | ||
*The majority of patients with synovial sarcoma remain asymptomatic for years. | * There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for synovial sarcoma. | ||
*Early clinical feature includes a soft palpable mass. | |||
*If left untreated, patients with synovial sarcoma may progress to develop metastases | == Natural History, Complications, and Prognosis== | ||
*The most common | *The majority of [[Patient|patients]] with synovial sarcoma remain [[asymptomatic]] for years. | ||
*Prognosis is generally poor, and the median survival rate of patients with synovial sarcoma is approximately 35% to 60%. | *Early [[clinical]] feature includes a soft [[Palpation|palpable]] mass. | ||
*The table below demonstrates the good and poor prognostic factors for patients with synovial sarcoma.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | *If left untreated, [[Patient|patients]] with synovial sarcoma may progress to develop [[Metastasis|metastases]]. | ||
*The most common [[Complication (medicine)|complication]] of synovial sarcoma is [[Lung|pulmonary]] cannonball [[Metastasis|metastases]]. | |||
*[[Prognosis]] is generally poor, and the [[median]] survival rate of [[Patient|patients]] with synovial sarcoma is approximately 35% to 60%. | |||
*The table below demonstrates the good and poor [[Prognosis|prognostic]] factors for [[Patient|patients]] with synovial sarcoma.<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | |||
:{| class="wikitable" | :{| class="wikitable" | ||
! style="font-weight: bold;" | Poor prognosis | ! style="font-weight: bold;" | Poor prognosis | ||
| Line 76: | Line 79: | ||
|- | |- | ||
| | | | ||
*Large size (>5 cm): most important factor | *Large size (> 5 cm): most important factor | ||
*Located in the trunk or head and neck | *Located in the [[trunk]] or [[head]] and [[neck]] | ||
*Older patients | *Older [[Patient|patients]] | ||
*Cystic/ | *[[Cyst|Cystic]]/[[hemorrhagic]] components | ||
*Marked heterogeneity | *Marked [[Heterogeneous|heterogeneity]] | ||
*Histology | *[[Histology]] | ||
:*Poorly differentiated histology | :*Poorly differentiated [[histology]] | ||
:*Extensive | :*Extensive [[tumor]] [[necrosis]] | ||
:*High nuclear grade | :*High [[Cell nucleus|nuclear]] grade | ||
:*p53 mutations | :*[[p53]] [[Mutation|mutations]] | ||
:*High mitotic rate (>10 mitoses per 10 high-power field) | :*High [[Mitosis|mitotic]] rate (> 10 [[Mitosis|mitoses]] per 10 high-power field) | ||
| | | | ||
*Small size | *Small size | ||
*Located in extremity | *Located in extremity | ||
*Younger age <20 years of age | *Younger age < 20 years of age | ||
*Solid homogenous mass | *Solid [[Homogeneity|homogenous]] mass | ||
*Presence of calcification | *Presence of [[calcification]] | ||
*Biphasic histology (controversial) | *Biphasic [[histology]] (controversial) | ||
|} | |} | ||
== Diagnosis == | == Diagnosis == | ||
===Diagnostic | ===Diagnostic Study of Choice=== | ||
* The diagnosis of synovial sarcoma is typically made based on histology and is confirmed by the presence of t(X;18).<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | * The [[diagnosis]] of synovial sarcoma is typically made based on [[histology]] and is confirmed by the presence of t(X;18).<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
=== Symptoms === | === History and Symptoms === | ||
*Synovial sarcoma is usually asymptomatic. | *Synovial sarcoma is usually [[asymptomatic]]. | ||
*Symptoms of synovial sarcoma may include the following:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | *[[Symptom|Symptoms]] of synovial sarcoma may include the following:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
:*Soft tissue mass | :*[[Soft tissue]] mass | ||
:*Localized pain | :*Localized [[pain]] | ||
:*Limited range of motion | :*Limited [[range of motion]] | ||
*Specific areas of focus when obtaining the history | *Specific areas of focus when obtaining the history include: | ||
:*Localized pain | :*Localized [[pain]] | ||
:*Accompanying local swelling or mass, progressive pain that is not relieved with rest, night pain | :*Accompanying local swelling or mass, progressive [[pain]] that is not relieved with rest, night [[pain]] | ||
:*Recent weight loss (or failure to thrive) | :*Recent [[weight loss]] (or [[failure to thrive]]) | ||
:*Personal history of cancer | :*Personal history of [[cancer]] | ||
:*Family history of bone tumors | :*[[Family history]] of [[Bone tumor|bone tumors]] | ||
=== Physical Examination === | === Physical Examination === | ||
*Patients with synovial sarcoma usually are well-appearing. | *[[Patient|Patients]] with synovial sarcoma usually are well-appearing. | ||
*Physical examination may be remarkable for: | *[[Physical examination]] may be remarkable for: | ||
:*Tenderness to palpation | :*[[Tenderness]] to [[palpation]] | ||
:*Soft tissue swelling | :*[[Soft tissue]] [[swelling]] | ||
:*Decreased range of motion | :*Decreased [[range of motion]] | ||
:*[[Muscle atrophy]] | :*[[Muscle atrophy]] | ||
:*Joint effusion | :*[[Joint]] effusion | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
*There are no specific laboratory findings associated with synovial sarcoma. | *There are no specific [[Medical laboratory|laboratory]] findings associated with synovial sarcoma. | ||
=== Electrocardiogram === | |||
* There are no [[The electrocardiogram|ECG]] findings associated with synovial sarcoma. | |||
===Imaging Findings=== | ===Imaging Findings=== | ||
*MRI is the imaging modality of choice for synovial sarcoma. | *[[Magnetic resonance imaging|MRI]] is the imaging modality of choice for synovial sarcoma. | ||
*On ultrasound, characteristic findings of synovial sarcoma, include:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | *On ultrasound, characteristic findings of synovial sarcoma, include:<ref name="pmid9930576">{{cite journal |vauthors=Fisher C |title=Synovial sarcoma |journal=Ann Diagn Pathol |volume=2 |issue=6 |pages=401–21 |year=1998 |pmid=9930576 |doi= |url=}}</ref> | ||
:*Non-specific | :*Non-specific | ||
Revision as of 16:43, 9 May 2019
|
WikiDoc Resources for Synovial sarcoma |
|
Articles |
|---|
|
Most recent articles on Synovial sarcoma Most cited articles on Synovial sarcoma |
|
Media |
|
Powerpoint slides on Synovial sarcoma |
|
Evidence Based Medicine |
|
Clinical Trials |
|
Ongoing Trials on Synovial sarcoma at Clinical Trials.gov Trial results on Synovial sarcoma Clinical Trials on Synovial sarcoma at Google
|
|
Guidelines / Policies / Govt |
|
US National Guidelines Clearinghouse on Synovial sarcoma NICE Guidance on Synovial sarcoma
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
Patient resources on Synovial sarcoma Discussion groups on Synovial sarcoma Patient Handouts on Synovial sarcoma Directions to Hospitals Treating Synovial sarcoma Risk calculators and risk factors for Synovial sarcoma
|
|
Healthcare Provider Resources |
|
Causes & Risk Factors for Synovial sarcoma |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: Malignant synovioma
Overview
Synovial sarcoma (also known as malignant synovioma) is a very rare form of soft tissue sarcoma, which usually occurs near the joints in upper and lower extremities. Synovial sarcoma was first discovered by Pack and Tabah in 1955. Synovial sarcoma may be classified according to histopathological findings into 4 subtypes: biphasic, monophasic fibrous (most common), monophasic epithelial, and poorly differentiated. The pathogenesis of synovial sarcoma is characterized by the dysregulation of gene expression of SYT-SSX gene. The most common location for these synovial sarcoma, include: knee, adjacent to large joints, and popliteal fossa.[1] The SYT-SSX fusion gene (located in chromosome 18) has been associated with the development of synovial sarcoma. Synovial sarcomas account for 2.5-10% of all soft tissue sarcoma, and it is more commonly observed among adolescents and young adults. The diagnosis of synovial sarcoma is typically made based on histology and is confirmed by the presence of t(X;18).[1] MRI is the imaging modality of choice for synovial sarcoma. Surgical resection in conjunction with chemotherapy or radiation is the most common approach to the treatment of synovial sarcoma.[1]
Historical Perspective
- Synovial sarcoma was first discovered by Pack and Tabah in 1955.[2]
Classification
- Synovial sarcoma may be classified according to histopathological findings into 4 sub-types:[1]
- Biphasic
- Monophasic fibrous (most common)
- Monophasic epithelial
- Poorly differentiated
Pathophysiology
- The pathogenesis of synovial sarcoma is characterized by the dysregulation of gene expression of SYT-SSX gene.[1]
- The most common locations for the occurrence of synovial sarcoma include:[2]
- Knee
- Adjacent to large joints
- Popliteal fossa
- The SYT-SSX fusion gene (located in chromosome 18) has been associated with the development of synovial sarcoma.
- On gross pathology, characteristic findings of synovial sarcoma include:
- Solid often lobulated
- Grey-yellow
- Pushing border to ill-defined border
- On microscopic histopathological analysis, characteristic findings of synovial sarcoma include:[1]
- Non-specific appearances
- Well or poorly defined heterogeneous masses
- Frequent areas of hemorrhage
- Necrosis
Causes
- There are no established causes for synovial sarcoma.
Differentiating Synovial Sarcoma from Other Diseases
- Synovial sarcoma must be differentiated from other diseases that cause joint pain, mass growth, and limited range of motion, such as:[1]
Epidemiology and Demographics
- The prevalence of synovial sarcoma remains unknown.[1]
- Synovial sarcomas account for 2.5 - 10% of all soft tissue sarcomas.
Age
- Synovial sarcoma is more commonly observed among patients aged 15 - 40 years old.
- Synovial sarcoma is more commonly observed among adolescents and young adults.
Gender
- Males are more commonly affected with synovial sarcoma than females.
- The male to female ratio is approximately 1.2 to 1.
Race
- There is no racial predilection for synovial sarcoma.[1]
Risk Factors
- There are no known risk factors associated with the development of synovial sarcoma.[2]
Screening
- There is insufficient evidence to recommend routine screening for synovial sarcoma.
Natural History, Complications, and Prognosis
- The majority of patients with synovial sarcoma remain asymptomatic for years.
- Early clinical feature includes a soft palpable mass.
- If left untreated, patients with synovial sarcoma may progress to develop metastases.
- The most common complication of synovial sarcoma is pulmonary cannonball metastases.
- Prognosis is generally poor, and the median survival rate of patients with synovial sarcoma is approximately 35% to 60%.
- The table below demonstrates the good and poor prognostic factors for patients with synovial sarcoma.[1]
Poor prognosis Good prognosis - Large size (> 5 cm): most important factor
- Located in the trunk or head and neck
- Older patients
- Cystic/hemorrhagic components
- Marked heterogeneity
- Histology
- Small size
- Located in extremity
- Younger age < 20 years of age
- Solid homogenous mass
- Presence of calcification
- Biphasic histology (controversial)
Diagnosis
Diagnostic Study of Choice
- The diagnosis of synovial sarcoma is typically made based on histology and is confirmed by the presence of t(X;18).[1]
History and Symptoms
- Synovial sarcoma is usually asymptomatic.
- Symptoms of synovial sarcoma may include the following:[1]
- Soft tissue mass
- Localized pain
- Limited range of motion
- Specific areas of focus when obtaining the history include:
- Localized pain
- Accompanying local swelling or mass, progressive pain that is not relieved with rest, night pain
- Recent weight loss (or failure to thrive)
- Personal history of cancer
- Family history of bone tumors
Physical Examination
- Patients with synovial sarcoma usually are well-appearing.
- Physical examination may be remarkable for:
- Tenderness to palpation
- Soft tissue swelling
- Decreased range of motion
- Muscle atrophy
- Joint effusion
Laboratory Findings
- There are no specific laboratory findings associated with synovial sarcoma.
Electrocardiogram
- There are no ECG findings associated with synovial sarcoma.
Imaging Findings
- MRI is the imaging modality of choice for synovial sarcoma.
- On ultrasound, characteristic findings of synovial sarcoma, include:[1]
- Non-specific
- Heterogeneous
- Hypoechoic mass
- On CT, characteristic findings of synovial sarcoma, include:
- Non-specific
- Soft tissue mass
- Heterogeneous density and enhancement
- Calcifications
- On MRI, characteristic findings of synovial sarcoma, include:[1]
- T1: iso- (slightly hyper-) intense to muscle/ heterogeneous
- T2: mostly hyperintense, markedly heterogeneous appearance of synovial cell sarcomas on fluid sensitive sequences result in so called "triple sign" which is due to areas of necrosis and cystic degeneration with very high signal, relatively high signal soft tissue components, and areas of low signal intensity due to dystrophic calcifications and fibrotic bands, due to high tendency of lesions to bleed, there might be areas of fluid-fluid levels known as "bowl of grapes" are seen in up to 10-25% of cases
- T1 C + (Gd): enhancement is usually prominent and can be diffuse (40%) heterogeneous (40%) or peripheral (20%)
- The image below demonstrates an MRI image of synovial sarcoma.
-
MRI: Synovial sarcoma
Treatment
Medical Therapy
- The mainstay of therapy for synovial sarcoma, includes:[1]
Surgery
- Surgery is the mainstay of therapy for synovial sarcoma.[2]
- Surgical resection in conjunction with chemotherapy or radiation is the most common approach to the treatment of synovial sarcoma.[1]
Prevention
- There are no primary preventive measures available for synovial sarcoma.
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Fisher C (1998). "Synovial sarcoma". Ann Diagn Pathol. 2 (6): 401–21. PMID 9930576.
- ↑ 2.0 2.1 2.2 2.3 Gomatos IP, Alevizos L, Kafiri G, Bramis J, Leandros E (2009). "Management of a small incidentally discovered retroperitoneal synovial sarcoma". Can J Surg. 52 (5): E199–200. PMC 2769101. PMID 19865558.