Skip to main content

Advertisement

SpringerLink
Log in

Synovial sarcoma presenting as an avascular mass: radiologic-pathologic correlation

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Synovial sarcoma is a well-recognized soft tissue malignancy that typically arises in young adults. It is now generally accepted that its origin is likely from undifferentiated mesenchymal tissue with variable epithelial differentiation and a highly specific chromosomal translocation in more than 95 % of cases. The lesion typically presents as a slow-growing soft tissue mass, with MR imaging demonstrating a heterogeneous mass with variable amounts of low-, intermediate- and high-signal intensity on fluid-sensitive images and prominent heterogeneous enhancement, reflecting its vascularity. The relative hypervascularity of synovial sarcoma has been well established and is reflected in its enhancement on MR imaging studies. Contrast enhancement on MR imaging has been long used as a marker for tissue vascularization and perfusion, with malignant lesions generally being more vascular and enhancing more rapidly. We recently encountered a patient with a high-grade synovial sarcoma with no discernable necrosis and no vascularity on contrast-enhanced MR images with the subtraction technique, despite enhancement in adjacent regional metastatic lymph nodes. The pathologic basis for this unusual imaging appearance was a paucity of small-caliber vessels within the sarcoma due to extensive hyalinization of the mass.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Suurmeijer AJH, de Bruijn D, Geurts van Kessel A, Miettinen MM. Synovial sarcoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO Classification of Tumors of Soft Tissue and Bone. Lyon: IARC Press; 2013. p. 213–5.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Cadman NL, Soule EH, Kelly PJ. Synovial sarcoma; an analysis of 34 tumors. Cancer. 1965;18:613–27.

    Article  CAS  PubMed  Google Scholar 

  4. Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J Surg Oncol. 2008;97(4):314–20.

    Article  PubMed  Google Scholar 

  5. O’Sullivan PJ, Harris AC, Munk PL. Radiological features of synovial cell sarcoma. Br J Radiol. 2008;81(964):346–56.

    Article  PubMed  Google Scholar 

  6. Wright PH, Sim FH, Soule EH, Taylor WF. Synovial sarcoma. J Bone Joint Surg Am. 1982;64(1):112–22.

    CAS  PubMed  Google Scholar 

  7. Blacksin MF, Siegel JR, Benevenia J, Aisner SC. Synovial sarcoma: frequency of nonaggressive MR characteristics. J Comput Assist Tomogr. 1997;21(5):785–9.

    Article  CAS  PubMed  Google Scholar 

  8. Bernreuter WK, Sartoris DJ, Resnick D. Magnetic resonance imaging of synovial sarcoma. J Foot Surg. 1990;29(1):94–100.

    CAS  PubMed  Google Scholar 

  9. Hirsch RJ, Yousem DM, Loevner LA, Montone KT, Chalian AA, Hayden RE, et al. Synovial sarcomas of the head and neck: MR findings. AJR Am J Roentgenol. 1997;169(4):1185–8.

    Article  CAS  PubMed  Google Scholar 

  10. Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol. 1993;161(4):827–30.

    Article  CAS  PubMed  Google Scholar 

  11. Morton MJ, Berquist TH, McLeod RA, Unni KK, Sim FH. MR imaging of synovial sarcoma. AJR Am J Roentgenol. 1991;156(2):337–40.

    Article  CAS  PubMed  Google Scholar 

  12. Sigal R, Chancelier MD, Luboinski B, Shapeero LG, Bosq J, Vanel D. Synovial sarcomas of the head and neck: CT and MR findings. AJNR Am J Neuroradiol. 1992;13(5):1459–62.

    CAS  PubMed  Google Scholar 

  13. Lois JF, Fischer HJ, Mirra JM, Gomes AS. Angiography of histopathologic variants of synovial sarcoma. Acta Radiol Diagn (Stockh). 1986;27(4):449–54.

    CAS  Google Scholar 

  14. van Rijswijk CS, Hogendoorn PC, Taminiau AH, Bloem JL. Synovial sarcoma: dynamic contrast-enhanced MR imaging features. Skelet Radiol. 2001;30(1):25–30.

    Article  Google Scholar 

  15. Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M. Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging–parametric "first-pass" images depict tissue vascularization and perfusion. Radiology. 1994;192(3):835–43.

    Article  CAS  PubMed  Google Scholar 

  16. van der Woude HJ, Verstraete KL, Hogendoorn PC, Taminiau AH, Hermans J, Bloem JL. Musculoskeletal tumors: does fast dynamic contrast-enhanced subtraction MR imaging contribute to the characterization? Radiology. 1998;208(3):821–8.

    Article  PubMed  Google Scholar 

  17. van Rijswijk CS, Geirnaerdt MJ, Hogendoorn PC, Taminiau AH, van Coevorden F, Zwinderman AH, et al. Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology. 2004;233(2):493–502.

    Article  PubMed  Google Scholar 

  18. Jin L, Majerus J, Oliveira A, Inwards CY, Nascimento AG, Burgart LJ, et al. Detection of fusion gene transcripts in fresh-frozen and formalin-fixed paraffin-embedded tissue sections of soft-tissue sarcomas after laser capture microdissection and RT-PCR. Diagn Mol Pathol. 2003;12(4):224–30.

    Article  CAS  PubMed  Google Scholar 

  19. Kransdorf MJ, Murphey MD. Imaging of Soft Tissue Tumors. Philadelphia: Lippincott Williams & Wilkins; 2014.

    Google Scholar 

  20. Ishida T, Iijima T, Moriyama S, Nakamura C, Kitagawa T, Machinami R. Intra-articular calcifying synovial sarcoma mimicking synovial chondromatosis. Skelet Radiol. 1996;25(8):766–9.

    Article  CAS  Google Scholar 

  21. McCarville MB, Spunt SL, Skapek SX, Pappo AS. Synovial sarcoma in pediatric patients. AJR Am J Roentgenol. 2002;179(3):797–801.

    Article  PubMed  Google Scholar 

  22. Paulino AC. Synovial sarcoma prognostic factors and patterns of failure. Am J Clin Oncol. 2004;27(2):122–7.

    Article  PubMed  Google Scholar 

  23. Ryan JR, Baker LH, Benjamin RS. The natural history of metastatic synovial sarcoma: experience of the Southwest Oncology group. Clin Orthop Relat Res. 1982;164:257–60.

    PubMed  Google Scholar 

  24. Sutro CJ. Synovial sarcoma of the soft parts in the 1st toe: recurrence after a 35 year interval. Bull Hosp Joint Dis. 1976;37(2):105–9.

    CAS  PubMed  Google Scholar 

  25. Ariel IM. Incidence of metastases to lymph nodes from soft-tissue sarcomas. Semin Surg Oncol. 1988;4(1):27–9.

    Article  CAS  PubMed  Google Scholar 

  26. Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987;60(8):1800–8.

    Article  CAS  PubMed  Google Scholar 

  27. Meyer CA, Kransdorf MJ, Moser Jr RP, Jelinek JS. Case report 716. Soft-tissue metastasis in synovial sarcoma. Skelet Radiol. 1992;21(2):128–31.

    Article  CAS  Google Scholar 

  28. Treu EB, de Slegte RG, Golding RP, Sperber M, van Zanten TE, Valk J. CT findings in paravertebral synovial sarcoma. J Comput Assist Tomogr. 1986;10(3):460–2.

    CAS  PubMed  Google Scholar 

  29. Vezeridis MP, Moore R, Karakousis CP. Metastatic patterns in soft-tissue sarcomas. Arch Surg. 1983;118(8):915–8.

    Article  CAS  PubMed  Google Scholar 

  30. Dos Santos R. Angiography in bone tumors. J Bone Joint Surg. 1950;32B(1):17–29.

    Google Scholar 

  31. Ma LD, Frassica FJ, McCarthy EF, Bluemke DA, Zerhouni EA. Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios. Radiology. 1997;202(3):739–44.

    Article  CAS  PubMed  Google Scholar 

  32. 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(5):1543–65.

    Article  PubMed  Google Scholar 

  33. Weiss SW, Goldblum JR. Malignant soft tissue tumors of uncertain type. In: Weiss WS, Goldblum JR, editors. Enzinger & Weiss’s Soft Tissue Tumors. 5th ed. Philadelphia: Mosby Elsevier; 2008. p. 1161–220.

  34. Fletcher CDM. Soft tissue tumors. Diagnostic histopathology of tumors. 3rd ed. Philadelphia: Elsevier; 2007. p. 1527–92.

    Google Scholar 

  35. Sundaram M, McGuire MH, Schajowicz F. Soft-tissue masses: histologic basis for decreased signal (short T2) on T2-weighted MR images. AJR Am J Roentgenol. 1987;148(6):1247–50.

    Article  CAS  PubMed  Google Scholar 

Download references

Declaration

The authors declare they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Ann E. McCullough & Veronica L. Taylor

  2. Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Adam J. Schwartz

  3. Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Mark J. Kransdorf

Authors
  1. Ann E. McCullough
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam J. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica L. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark J. Kransdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark J. Kransdorf.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McCullough, A.E., Schwartz, A.J., Taylor, V.L. et al. Synovial sarcoma presenting as an avascular mass: radiologic-pathologic correlation. Skeletal Radiol 44, 279–284 (2015). https://doi.org/10.1007/s00256-014-1964-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-014-1964-9

Keywords

Search

Navigation