Outani Hidetatsu, Hamada Kenichiro, Oshima Kazuya, Joyama Susumu, Naka Norifumi, Araki Nobuhito, Ueda Takafumi, Yoshikawa Hideki
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka 565-0871 Japan.
Musculoskeletal Oncology Service, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashiknari, Osaka 537-8511 Japan.
Springerplus. 2014 Nov 3;3:649. doi: 10.1186/2193-1801-3-649. eCollection 2014.
Soft tissue sarcoma of the hand is rare, and one of the most common histological diagnosis is synovial sarcoma. We report the clinical outcomes of patients with synovial sarcoma of the hand and discuss treatment strategies.
We reviewed five patients with synovial sarcoma of the hand treated at our institutions from 1983 to 2013. The mean patient age at the time of diagnosis was 36.6 years (range, 20-62 years). Two patients underwent marginal excision after neoadjuvant chemotherapy, followed by radiation therapy, one underwent wide local excision and two received chemotherapy and radiation therapy.
The average duration of follow-up for all patients was 88.2 months (range, 14-218 months). Two patients continuously remained disease free, two experienced local recurrence requiring additional surgery and then showed no evidence of disease, and one who had distant metastasis at diagnosis died of the disease. No patients developed lymph node metastasis. The estimated 5-year overall survival was 80%.
Our case series suggests that patients with localised synovial sarcoma of the hand may have favourable outcomes. Wide excision or marginal excision, followed by radiation therapy combined with chemotherapy, represent acceptable treatment strategies for synovial sarcoma of the hand. Regional lymph node dissection does not seem to be essential for synovial sarcoma of the hand.
手部软组织肉瘤较为罕见，最常见的组织学诊断之一是滑膜肉瘤。我们报告手部滑膜肉瘤患者的临床结果并讨论治疗策略。
我们回顾了1983年至2013年在我们机构接受治疗的5例手部滑膜肉瘤患者。诊断时患者的平均年龄为36.6岁（范围20 - 62岁）。2例患者在新辅助化疗后行边缘性切除，随后进行放射治疗，1例行广泛局部切除，2例接受化疗和放射治疗。
所有患者的平均随访时间为88.2个月（范围14 - 218个月）。2例患者持续无病生存，2例出现局部复发需要再次手术，之后无疾病证据，1例在诊断时发生远处转移，死于该疾病。无患者发生淋巴结转移。估计5年总生存率为80%。
我们的病例系列表明，手部局限性滑膜肉瘤患者可能有良好的预后。广泛切除或边缘性切除，随后联合化疗和放射治疗，是手部滑膜肉瘤可接受的治疗策略。区域淋巴结清扫对手部滑膜肉瘤似乎并非必要。
