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Intra-articular synovial sarcoma

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Abstract

A case of right knee intra-articular synovial sarcoma in a 26-year-old man is reported. The patient had experienced 12 to 18 months of chronic posterior right knee pain with flexion contracture of the leg. Magnetic resonance imaging (MRI) examination demonstrated nonspecific characteristics of a well-circumscribed, homogeneous mass within the posterior lateral compartment of the knee joint. The mass was isointense and hyperintense to muscle on T1- and T2-weighted sequences respectively, and initially clinically diagnosed as a localized tenosynovial giant cell tumor. However, histological examination showed the lesion to be a synovial sarcoma arising from the synovium of the knee joint. Synovial sarcoma may have a nonspecific MR appearance, especially when less than 5 cm in size, often simulating a less aggressive process. Primary intra-articular origin may predispose to earlier presentation, and therefore, radiological evaluation of smaller masses. Nonspecific MR characteristics of small, intra-articular masses provide a diagnostic dilemma. Synovial sarcoma should be considered in the differential diagnosis when distinguishing MR characteristics of other common joint-centered entities are not present.

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References

  1. Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. Am J Roentgenol. 1995;164:129–34.

    Article  CAS  Google Scholar 

  2. Ries LAG, Smith MA, Gurney JG, et al. Cancer incidence and survival among children and adolescents: U.S. Surveillance, Epidemiology, and End Results (SEER) Program 1975–1995. Bethesda: National Cancer Institute, NIH Publication; 1999. NIH Pub.No. 99-4649.

    Google Scholar 

  3. Weiss SW, Goldblum JR, editors. Enzinger and Weiss’s soft tissue tumors. 5th ed. St Louis: Elsevier; 2008. p. 1161–82.

    Google Scholar 

  4. Frank SJ, Snearly W, Parsons T. Malignant tumours about the knee. Am J Knee Surg. 1988;1:257–66.

    Google Scholar 

  5. Spillane A, A’Hern R, Judson I, Fisher C, Meirion Thomas J. Synovial sarcoma: a clinicopathologic, staging and prognostic assessment. J Clin Oncol. 2000;18:3794–803.

    PubMed  CAS  Google Scholar 

  6. Cadman NL, Soule EH. Synovial sarcoma: an analysis of 134 tumors. Cancer. 1965;18:613–27.

    Article  PubMed  CAS  Google Scholar 

  7. McLain R, Buckwalter J, Platz CE. Synovial sarcoma of the knee: missed diagnosis despite biopsy and arthroscopic synovectomy. J Bone Joint Surg Am. 1990;72:1092–4.

    PubMed  CAS  Google Scholar 

  8. Fetsch JF, Meis JM. Intra-articular synovial sarcoma. Mod Pathol. 1992;5:6A.

    Google Scholar 

  9. McKinney CD, Mills SE, Fechner RE. Intraarticular synovial sarcoma. Am J Surg Pathol. 1992;16:1017–20.

    Article  PubMed  CAS  Google Scholar 

  10. Ishida T, Iijima T, Moriyama S, Nakamura C, Kitagawa T, Machinami R. Intra-articular calcifying synovial sarcoma mimicking synovial chondromatosis. Skeletal Radiol. 1996;25:766–9.

    Article  PubMed  CAS  Google Scholar 

  11. Scully RE, Mark EJ, McNeely WF, et al. Case records of the Massachusetts general hospital case 1–2001. N Engl J Med. 2001;344:124–31.

    Article  Google Scholar 

  12. Namba Y, Kawai A, Naito N, Morimoto Y, Hanakawa S, Inoue H. Intraarticular synovial sarcoma confirmed by SYT-SSX fusion transcript. Clin Orthop Relat Res. 2002;395:221–6.

    Article  PubMed  Google Scholar 

  13. Kan JH. MRI features of three paediatric intra-articular synovial lesions: a comparative study. Clin Radiol. 2008;63:805–12.

    Article  PubMed  CAS  Google Scholar 

  14. Bui-Mansfield LT, O’Brien SD. Magnetic resonance appearance of intra-articular synovial sarcoma: case reports and review of the literature. J Comput Assist Tomogr. 2008;32:640–4.

    Article  PubMed  Google Scholar 

  15. Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging finding in 34 patients. Am J Roentgenol. 1993;161:827–30.

    Article  CAS  Google Scholar 

  16. Morton MJ, Berquist TH, McLeod RA, Unni KK, Sim FH. MR imaging of synovial sarcoma. Am J Roentgenol. 1991;156:337–40.

    Article  CAS  Google Scholar 

  17. Haagensen CH, Stout AP. Synovial sarcoma. Ann Surg. 1944;120:826–42.

    PubMed  CAS  Google Scholar 

  18. Berger L. Synovial sarcomas in serous bursae and tendon sheaths. Am J Cancer. 1938;34:501–39.

    Google Scholar 

  19. Murphey MD, Gibson MS, Jennings BT, Crespo-Rodriguez AM, Fanburg-Smith J, Gajewski DA. From the archives of the AFIP: imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006;26:1543–65.

    Article  PubMed  Google Scholar 

  20. Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res. 2004;419:155–61.

    Article  PubMed  Google Scholar 

  21. Ferrari A, Gronchi A, Casanova M, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004;101:627–34.

    Article  PubMed  Google Scholar 

  22. Pack GT, Ariel IM. Synovial sarcoma (malignant synovioma) report of 60 cases. Surgery. 1950;28:1047–84.

    PubMed  CAS  Google Scholar 

  23. Gerner RE, Moore GE. Synovial sarcoma. Ann Surg. 1975;181:22–5.

    Article  PubMed  CAS  Google Scholar 

  24. Ariel IM, Pack GT. Synovial sarcoma - review of 25 cases. N Engl J Med. 1963;268:1272–5.

    Article  PubMed  CAS  Google Scholar 

  25. Wright PH, Sim FH, Soule EH, Taylor WF. Synovial sarcoma. J Bone Joint Surg Am. 1982;64:112–22.

    PubMed  CAS  Google Scholar 

  26. Dardick I, O’Brien PK, Jeans MTD, Massiah KA. Synovial sarcoma arising in an anatomical bursa. Virchows Arch A Pathol Anat Histopathol. 1982;397:93–101.

    Article  CAS  Google Scholar 

  27. Ayoub KS, Davies AM, Mangham DC, Grimer RJ, Twiston Davies CW. Synovial sarcoma arising in association with a popliteal cyst. Skeletal Radiol. 2000;29:713–6.

    Article  PubMed  CAS  Google Scholar 

  28. Kransdorf MJ, Jelinek JS, Moser RP, et al. Soft-tissue masses: diagnosis using MR imaging. Am J Roentgenol. 1989;153:541–7.

    Article  CAS  Google Scholar 

  29. Sundaram M, McGuire MH, Fletcher J, Wolverson MK, Heiberg E, Shields JB. Magnetic resonance imaging of lesions of synovial origin. Skeletal Radiol. 1986;15:110–6.

    Article  PubMed  CAS  Google Scholar 

  30. Blacksin MF, Siegel JR, Benevenia J, Aisner SC. Synovial sarcoma: frequency of nonaggressive MR characteristics. J Comput Assist Tomogr. 1997;21:785–9.

    Article  PubMed  CAS  Google Scholar 

  31. Tateishi U, Hasegawa T, Beppu Y, Satake M, Moriyama N. Synovial sarcoma of the soft tissues: prognostic significance of imaging features. J Comput Assist Tomogr. 2004;28:140–8.

    Article  PubMed  Google Scholar 

  32. Sheldon PF, Forrester DM, Learch TF. Imaging of intraarticular masses. Radiographics. 2005;25:105–19.

    Article  PubMed  Google Scholar 

  33. Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. Am J Roentgenol. 2003;181:539–43.

    Article  Google Scholar 

  34. Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008;28:1493–518.

    Article  PubMed  Google Scholar 

  35. Li PK, James SL, Davies AM. Tumour and tumour-like lesions of the intercondylar notch of the knee: a pictorial review. J Med Imaging Radiat Oncol. 2008;52:434–46.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA

    Michael V. Friedman, Jack W. Jennings & Daniel E. Wessell

  2. Division of Surgical Pathology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8118, St. Louis, MO, 63110, USA

    Michael Kyriakos

  3. Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA

    Matthew J. Matava & Douglas J. McDonald

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  1. Michael V. Friedman
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Correspondence to Michael V. Friedman.

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Friedman, M.V., Kyriakos, M., Matava, M.J. et al. Intra-articular synovial sarcoma. Skeletal Radiol 42, 859–867 (2013). https://doi.org/10.1007/s00256-013-1589-4

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  • DOI: https://doi.org/10.1007/s00256-013-1589-4

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