Abstract
Objective
To assess the radiographic and clinicopathologic features of synovial sarcoma of the nerve that were clinically or radiologically interpreted as benign peripheral nerve sheath tumor.
Materials and methods
Five patients with synovial sarcoma arising from the peripheral nerve and interpreted clinically and radiologically as peripheral nerve sheath tumors were identified. Clinicopathologic and imaging features were evaluated.
Results
There were three females and two males, ranging in age from 28 to 50 (mean 35.8) years. Most patients (4/5) complained of a mass, discomfort or pain. MR images demonstrated a heterogeneous, enhancing, soft tissue mass contiguous with the neurovascular bundle. On histologic examination, most tumors were monophasic synovial sarcoma (4/5). At the time of surgery, all tumors were noted to arise along or within a peripheral nerve. All patients were alive with no evidence of disease with median follow-up of 44 (range 32–237) months. For comparison, approximately 775 benign peripheral nerve sheath tumors of the extremities were identified during the same time period.
Conclusions
Primary synovial sarcoma of the nerve can mimic peripheral nerve sheath tumors clinically and on imaging and should be included in the differential diagnosis for tumors arising from peripheral nerves.
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References
Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiogr Rev Publ Radiol Soc N Am Inc. 1999;19(5):1253–80.
Scheithauer BW, Amrami KK, Folpe AL, Silva AI, Edgar MA, Woodruff JM, et al. Synovial sarcoma of nerve. Hum Pathol. 2011;42(4):568–77.
Fisher C. Synovial sarcoma. Ann Diagn Pathol. 1998;2(6):401–21.
Reeves BR, Smith S, Fisher C, Warren W, Knight J, Martin C, et al. Characterization of the translocation between chromosomes X and 18 in human synovial sarcomas. Oncogene. 1989;4(3):373–8.
Kang S, Yoo HJ, Kim H-S, Han I. Soft tissue sarcoma misdiagnosed as benign peripheral neurogenic tumor. J Orthop Sci. 2015;20(1):180–5.
Shahid KR, Amrami KK, Spinner RJ. Primary monophasic synovial sarcoma presenting as a benign neurogenic tumor: case review and review of the literature. J Surg Orthop Adv. 2010;19(2):129–33.
Bixby SD, Hettmer S, Taylor GA, Voss SD. Synovial sarcoma in children: imaging features and common benign mimics. AJR Am J Roentgenol. 2010;195(4):1026–32.
Lipira AB, Kasukurthi R, Ray WZ, Pruzansky ME, Mackinnon SE. Intraneural synovial sarcoma of the median nerve. Rare Tumors [Internet]. 2010 30 [cited 2016 Nov 20];2(2). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994501/.
Ghiya AV, Ketkar MN, Patankar S, Kothari S. A rare case of synovial sarcoma involving the brachial plexus. Indian J Surg Oncol. 2011;2(1):24–6.
Pirouzmand F, Kommaraju K, Craddock KJ, Howarth D. Synovial sarcoma of the brachial plexus: case report. Neurosurgery. 2012;70(5):1329–33.
Tosi AL, Orcioni GF, de Biase D, Costantini S, Ishikawa Y, Eusebi V. Synovial sarcoma involving the median nerve: a case report. Turk Patoloji Derg. 2012;28(3):266–9.
Ng W, Thway K. Intraneural extension of synovial sarcoma: exceptional, or simply underrecognized? Int J Surg Pathol. 2015;23(8):649–51.
Kao Y-C, Sung Y-S, Zhang L, Kenan S, Singer S, Tap WD, et al. BCOR upregulation in a poorly differentiated synovial sarcoma with SS18L1-SSX1 fusion-a pathologic and molecular pitfall. Genes Chromosomes Cancer. 2017;56(4):296–302.
Trojani M, Contesso G, Coindre JM, Rouesse J, Bui NB, de Mascarel A, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. 1984;33(1):37–42.
Sultan I, Rodriguez-Galindo C, Saab R, Yasir S, Casanova M, Ferrari A. Comparing children and adults with synovial sarcoma in the surveillance, epidemiology, and end results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009;115(15):3537–47.
Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University health sciences center. J Neurosurg. 2005;102(2):246–55.
O’Sullivan PJ, Harris AC, Munk PL. Radiological features of synovial cell sarcoma. Br J Radiol. 2008;81(964):346–56.
Horowitz AL, Resnick D, Watson RC. The roentgen features of synovial sarcomas. Clin Radiol. 1973;24(4):481–4.
Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol. 1993;161(4):827–30.
Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990;155(6):1251–5.
Smith TA, Machen SK, Fisher C, Goldblum JR. Usefulness of cytokeratin subsets for distinguishing monophasic synovial sarcoma from malignant peripheral nerve sheath tumor. Am J Clin Pathol. 1999;112(5):641–8.
Weiss SW, Goldblum JR, Enzinger FM. Enzinger and Weiss’s Soft Tissue Tumors. 5th ed. Philadelphia: Mosby Elsevier; 2008. p. 872–8.
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We acknowledge the support from the Alfonso Martin Escudero Foundation.
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G. Petur Nielsen and Ivan Chebib are co-senior authors
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Larque, A.B., Bredella, M.A., Nielsen, G.P. et al. Synovial sarcoma mimicking benign peripheral nerve sheath tumor. Skeletal Radiol 46, 1463–1468 (2017). https://doi.org/10.1007/s00256-017-2710-x
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DOI: https://doi.org/10.1007/s00256-017-2710-x