Surgical management and outcome of synovial sarcoma in the spine

Abstract

BackgroundSynovial sarcoma (SS) is a soft tissue sarcoma that rarely occurs in the spine, and a minimal number of cases have been reported in the literature. Spinal SS is challenging in diagnosis and treatment and has a poor prognosis. The aim of this study was to summarize and analyse the clinical features and outcomes of patients with spinal SS.MethodsA total of 16 cases of patients with spinal SS admitted to our institution were reviewed retrospectively. General information, radiological findings and treatment strategies were collected. These patients were followed up regarding their continuing treatment, local or distant recurrence and survival.ResultsSpinal SS patients in this series ranged in age from 12 to 68 years (median, 33). Four en bloc resections and 12 piecemeal resections were performed. Improved Frankel (P = 0.002), visual analogue scale (P = 0.002) and Karnofsky Performance Status (P = 0.002) scores were seen postoperatively. The mean follow-up period was 35.9 ± 23.5 (median 31.5, range 4–87) months, with four local recurrences and three distant metastases detected. Eight patients (50.0%) died of disease by the last follow-up. The 1-, 3- and 5-year overall survival rates were 87.5%, 61.4% and 40.9%, respectively. Preoperative chemotherapy was used in three patients to facilitate surgical resection, and adjuvant chemotherapy and radiotherapy were used in six patients.ConclusionsSpinal SS has a relatively high risk of local recurrence and distant metastasis. Surgical intervention can improve the neurological function and relieve pain in these patients. En bloc excision is an effective treatment strategy to improve survival and prevent local recurrence. Management of spinal SS should be under the instruction of a multidisciplinary team.

Synovial Sarcoma of the Cervical Spine: Case Report

“…Radiotherapy has a well-established role in improving local control, especially after less-than-compartmental resection. [7] SS survival rates are best in young patients and those in whom a complete margin free resection is achievable. Worse prognosis is associated with no margin free resection, advanced age (> 25 years), tumor dimension greater than 5cm, tumor necrosis, vascular invasion, lower cellular differentiation, and high mitotic index [8,11,13].…”

“…There are no speci c symptoms or laboratory tests for the diagnosis of SS, therefore a high clinical suspicion is needed and these tumours can take a long time to be diagnosed. Pain, vertebral body collapse, spine instability and neurologic de cits may occur when these tumours affect the spine [7]. SS radiological aspect is variable but usually appears as a lithic lesion that may have sclerotic areas.…”

Synovial sarcoma of the spine: A case report and review of the literature

“…Nerve sheath tumors such as neurofibroma, schwannoma, or malignant peripheral nerve sheath tumor (MPNST) are among the differential diagnosis in the presence of solid lesions. [ 25 ] Schwannomas may be distinguished from SS by their eccentricity and encapsulation within the nerve bundle and can exhibit a mottled appearance on T2-weighted MRI. Neurofibromas are centrally positioned in relation to the nerve bundle with poorly defined borders and have nonhomogeneous signal intensity on T2-weighted MRI.…”

Synovial Sarcoma of the Spine: A Rare Intradural Extramedullary Tumour

“…Patient can have subcutaneous tissue metastasis although very rare. 11 Patients with metastatic disease have a poor prognosis, with a survival of less than two years. 12 The good prognostic factors include younger age, tumor size less than five cm, negative surgical margin after complete resection, and the administration of adjuvant radiotherapy.…”