Primary intra-articular epithelioid sarcoma of the knee: Unusual presentation of a rare entity

Flikweert, P.E.; Bollen, Thomas L.; Speth, Maria; Wolterbeek, N.; Timmerman, Leon

doi:10.1016/j.jor.2018.08.009

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…The diagnosis of extra-articular or intra-articular neoplasms via arthroscopy has been previously described [ 7 , 10 , 13 ]. Lewis and Reilly [ 10 ] reported 36 patients with musculoskeletal symptoms attributed to sports injuries later diagnosed with primary neoplasms.…”

Section: Discussionmentioning

confidence: 99%

“…Lesions commonly found in the knee are largely benign and include pigmented villonodular synovitis (PVNS) and synovial chondromatosis [ 2 , 3 ]. However, intra-articular primary sarcomas of the knee can also occur, including synovial sarcoma [ 4 ], osteosarcoma [ 5 ], extraskeletal chondrosarcoma [ 6 ], and epithelioid sarcoma [ 7 ]. Often these malignant masses are difficult to distinguish from benign tumors due to considerable overlap in clinical presentation [ 4 , 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Sarcoma Happens: A Reminder for Arthroscopic Surgeons

LiBrizzi¹,

Bitzer²,

Kreulen³

et al. 2022

Cureus

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Primary intra-articular sarcomas are rare and present with nonspecific symptoms such as pain or swelling. Due to nonspecific symptoms, patients may undergo routine diagnostic arthroscopy, which ultimately leads to sarcoma diagnosis. Here we present four patients with intra-articular sarcomas of the knee diagnosed after arthroscopy. The goal of this study is to highlight the importance of including malignant bone and soft-tissue sarcomas in the differential diagnosis of patients with nonspecific knee symptoms. A case series was developed from a retrospective review of prospectively collected data from our institution’s orthopedic oncology database. Patients who underwent arthroscopic procedures on the knee and who were diagnosed with intra-articular sarcomas postoperatively from 2014 to 2019 were identified. All patients underwent diagnosis, staging, and multidisciplinary evaluation and treatment. Clinical characteristics, oncologic considerations, and surgical outcomes are described. Four patients with intra-articular sarcomas of the knee diagnosed after arthroscopy for non-oncologic concerns were identified: two synovial sarcomas, one Ewing sarcoma of bone, and one osteosarcoma. All surgical plans and treatment options were significantly affected by the previous arthroscopic procedures. One patient underwent above-the-knee amputation; one patient underwent extra-articular wide resection of the knee, including portal sites with distal femur/total knee reconstruction; one patient underwent rotationplasty, and one patient was treated with therapeutic radiation (no surgery). All patients received chemotherapy. Although intra-articular sarcomas are rare, orthopaedic surgeons must remain vigilant when proceeding with arthroscopic procedures if the clinical history, physical exam, and imaging findings are not perfectly aligned.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sarcoma Happens: A Reminder for Arthroscopic Surgeons

LiBrizzi¹,

Bitzer²,

Kreulen³

et al. 2022

Cureus

View full text Add to dashboard Cite

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Delayed diagnosis of pediatric intra-articular epithelioid sarcoma: a case report and literature review

Zhang,

Liu,

Liu

et al. 2023

BMC Pediatr

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Background Epithelioid sarcoma (ES) is a rare form of mesenchymal malignancy that rarely occurs in children. Only seven cases of intra-articular epithelioid sarcoma have been reported in the medical literature. Case presentation In this report, we presented the case of a 13-year-old girl with a delayed diagnosis of ES in the left knee. Her initial diagnosis was mistaken for Pigmented Villonodular Synovitis (PVNS) but ruled out later by the first biopsy. However, the lesion rapidly regrew again after arthroscopy, raising suspicions of malignancy. A comprehensive histochemistry examination was conducted again, leading to the diagnosis of INI-1 negative epithelioid sarcoma. Unfortunately, the girl passed away seven months later due to early metastasis of the tumor. Conclusion Careful consideration should be given to the differential diagnosis of pediatric patients presenting with monoarthritis. This report highlights the importance of early and accurate diagnosis and underscores the necessity for effective treatments for epithelioid sarcoma. Surgical resection or radical surgery is recommended, while novel treatment strategies targeting EZH2 show promise.

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Primary intra-articular epithelioid sarcoma of the knee: Unusual presentation of a rare entity

Cited by 2 publications

References 6 publications

Sarcoma Happens: A Reminder for Arthroscopic Surgeons

Sarcoma Happens: A Reminder for Arthroscopic Surgeons

Delayed diagnosis of pediatric intra-articular epithelioid sarcoma: a case report and literature review

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