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Seronegative arthritis mimicking intratendinous synovial sarcoma: a review of imaging aids

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Abstract

A 36-year-old female, with newly diagnosed seronegative arthritis, presented with median nerve compression symptoms in her right hand. An ultrasound and MRI of the right wrist revealed a nine centimetre heterogenous, elongated, ill-defined solid lesion extending from the carpal tunnel to the mid-palm. A soft tissue sarcoma was suspected due to the size and extent of the neoplasm. A positron emission tomography (PET) scan demonstrated increased metabolic activity in the lesion. The sarcoma multi-disciplinary team (MDT) recommended an excisional biopsy. At surgery, a soft tissue mass was found involving the third lumbrical and parts of the flexor digitorum profundus of both the middle and ring fingers. The lesion was macroscopically excised en bloc with the third lumbrical. Histology revealed a benign lesion with no evidence of malignancy. The appearance was in keeping with inflammatory synovitis. This article reviews the imaging difficulties in distinguishing between benign and malignant hand neoplasms, the pitfalls of closed biopsy techniques in the hand, and investigative adjuncts to aid diagnosis.

Level of evidence: Level V, Diagnostic.

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Authors and Affiliations

  1. Department of Plastic & Reconstructive Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia

    Justin Yousef, Tzong-Yang Pan, Krishna Rao & Rostam Farhadieh

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  1. Justin Yousef
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  2. Tzong-Yang Pan
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  3. Krishna Rao
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  4. Rostam Farhadieh
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Correspondence to Justin Yousef.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is a case report. No ethics approval is warranted.

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Justin Yousef, Tzong-Yang Pan, Krishna Rao, and Rostam Farhadieh declare no competing interests.

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Yousef, J., Pan, TY., Rao, K. et al. Seronegative arthritis mimicking intratendinous synovial sarcoma: a review of imaging aids. Eur J Plast Surg 45, 993–996 (2022). https://doi.org/10.1007/s00238-022-01949-y

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  • DOI: https://doi.org/10.1007/s00238-022-01949-y

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