Intra-Articular Synovial Sarcoma Treated With a Transfemoral Amputation: A Case Report and Review of the Literature

Gresswell, Steven; Corsini, Anthony A.; Balsamo, Luke; Miles, Edward F.

doi:10.7205/milmed-d-13-00093

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…Differentiating intra-articular synovial sarcomas from benign tumors is difficult and no certain radiological features have been established. The most challenging differential diagnosis is localized PVNS [ 5 , 6 , 10 , 12 – 16 ]. Using multivariate data analysis this study showed that the most important variables for differentiation were size, effusion, age, and gender.…”

Section: Discussionmentioning

confidence: 99%

“…It merely reflects the histopathological similarities to developing synovial tissue [ 5 ]. No radiological distinguishing features have been established to differentiate intra-articular synovial sarcomas from benign tumors and in the literature there are only case reports or reviews of case reports [ 5 , 6 , 12 – 16 ]. In this study we reviewed 7 patients with intra-articular synovial sarcomas, which is a comparatively large material of these rare tumors.…”

Section: Introductionmentioning

confidence: 99%

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Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

Nordemar

Öberg

Brosjö

et al. 2015

Sarcoma

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Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal) pigmented villonodular synovitis (PVNS) and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA), were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

Nordemar

Öberg

Brosjö

et al. 2015

Sarcoma

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“…44 The majority of lower extremity synovial sarcomas arise in a PA location. 45 Three percent have been found to localize within the joint. 46 When they are discovered in an IA location, they can be difficult to distinguish from other masses including LPVNS.…”

Section: Synovial Sarcomamentioning

confidence: 99%

Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee

et al. 2018

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Intra-articular (IA) and peri-articular (PA) tumors of the knee are frequently encountered by orthopaedic surgeons. Nonetheless, due to the possibility of great morbidity and potential mortality, it is important to recognize and differentiate between benign and malignant lesions in a timely manner. Therefore, the purpose of this article is to provide a concise, practical, and updated review of commonly encountered IA and PA tumors including intratendinous gout, synovial chondromatosis, schwannoma, pigmented villonodular synovitis, and synovial sarcoma, and a detailed description of differentiating features to include various imaging modalities.

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“…Currently, 9 cases of intra-articular SS have been reported with specific MRI findings [25][26][27][28][29][30][31][32][33][34][35][36].…”

Section: Staging Treatment and Follow-upmentioning

confidence: 99%

Primary Intra-Articular Synovial Sarcoma of the Knee: A Report of Two Cases and Review of the Literature

E¹,

P²,

Heare³

et al. 2018

Int J Radiol Imaging Technol

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ond most common soft-tissue sarcoma in children and adolescents, after rhabdomyosarcoma [3].Approximately 80% of primary SS arise in the extremities, most commonly in the para-articular regions, the knee being the most common site. However, true intra-articular origin is extremely rare, accounting for less than 5% of cases [4][5][6][7]. From an oncological standpoint, SS is generally regarded as a high-grade sarcoma characterized by slow tumor growth, and a propensity to invade local structures. These tumors have a 30-60% incidence of metastases, which may sometimes develop more than 5 years after the initial diagnosis [8][9][10][11][12][13].Synovial sarcomas are often diagnosed after surgical excision of misdiagnosed benign lesions. Excision of these masses have shown to leave residual tumor in up to 82% of cases [14]. Low-risk synovial sarcomas in pediatric and adolescent patients treated with surgical excision alone show 72% -90% event-free survival at 5 years [15,16]. Intermediate and high risk tumors treated with surgery alone have a more variable 5-year survival between 36% -76%, which raises the need for adjuvant treatment [17]. Synovial sarcoma is relatively chemosensitive within the class of soft tissue sarcomas. A study of 313 cases of synovial sarcomas showed a 27.8% response to chemotherapy compared to 18.8% of other soft tissue sarcomas [18]. Ifosfamide and doxorubicin are the most efficacious chemotherapies for this tumor and have shown to result in 60% survival at 5 years in the absence of surgical excision. Chemotherapy combined with surgical excision and radiation therapy increases overall survival to 80-95% after 3 years [19,20]. AbstractCase: We highlight two cases of primary intra-articular lesions with imaging consistent with Pigmented Villonodular Synovitis (PVNS) and synovial chondromatosis. These benign neoplasms are typically treated with arthroscopic synovectomy. However fluid insufflation of the knee joint in the setting of intra-articular malignancies can dramatically change treatment options. Conclusion:Isolated intra-articular masses in the knee should have careful consideration of the differential diagnosis. These cases highlight the importance of adhering to diagnostic and treatment algorithms for the management of soft tissue masses to avoid potentially catastrophic complications. These cases support the consensus that arthroscopic excisional biopsy is not indicated as the primary procedure for an intra-articular soft tissue mass of unknown etiology.

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Intra-Articular Synovial Sarcoma Treated With a Transfemoral Amputation: A Case Report and Review of the Literature

Cited by 6 publications

References 26 publications

Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee

Primary Intra-Articular Synovial Sarcoma of the Knee: A Report of Two Cases and Review of the Literature

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