Subramanian Susanth, Jonathan Gandham Edmond, Patel Bimal, Prabhu Krishna
Department of Neurological Sciences, Christian Medical College, Vellore, India.
Department of Neuropathology, Christian Medical College, Vellore, India.
Br J Neurosurg. 2020 Feb;34(1):98-101. doi: 10.1080/02688697.2017.1418289. Epub 2018 Feb 15.
Synovial sarcoma is a rare mesenchymal malignant neoplasm that accounts for less than 10% of soft tissue sarcomas. About 95% of the sarcomas occur in the extremities. Primary synovial sarcomas of the spine are a rare tumor arising from the paravertebral regions, paraspinal muscles or epidural spaces. To report an atypical radiological presentation of synovial sarcoma of the thoracic spine mimicking a nerve sheath tumor in an elderly adult and describe the management with review of the literature. A forty-six-year-old lady presented with clinical features of a thoracic intradural extramedullary cord compression at T7 level. She was Nurick grade 4 at presentation. MRI of the Thoracic spine with whole spine screening showed a contrast enhancing intradural extramedullary tumor at the T7-8 level; the tumor was exiting out through the left T7-8 neural foramina with foraminal widening. The possibility of a schwannoma was considered. She underwent a T7-8 laminectomy and total excision of the tumor followed by posterior fusion. The biopsy was reported as synovial sarcoma. She subsequently underwent radiation and chemotherapy. She had marked improvement in her Neurological status and remained disease free at six months follow-up. Synovial sarcoma of the spine is a rare mesenchymal malignant neoplasm. One needs to consider Synovial sarcoma as one of the differential diagnosis of intradural tumors of the spine.
滑膜肉瘤是一种罕见的间叶性恶性肿瘤，占软组织肉瘤的比例不到10%。约95%的此类肉瘤发生于四肢。脊柱原发性滑膜肉瘤是一种罕见肿瘤，起源于椎旁区域、椎旁肌肉或硬膜外间隙。报告一例老年成人胸椎滑膜肉瘤的非典型影像学表现，类似神经鞘瘤，并结合文献复习描述其治疗方法。一名46岁女性表现出T7水平胸段硬膜内髓外脊髓受压的临床特征。就诊时她为Nurick 4级。胸椎MRI全脊柱筛查显示T7-8水平有一强化的硬膜内髓外肿瘤；肿瘤经左侧T7-8神经孔穿出，神经孔增宽。考虑为神经鞘瘤。她接受了T7-8椎板切除术及肿瘤全切，随后进行了后路融合术。活检报告为滑膜肉瘤。她随后接受了放疗和化疗。其神经功能状态有明显改善，随访6个月时无疾病复发。脊柱滑膜肉瘤是一种罕见的间叶性恶性肿瘤。需要将滑膜肉瘤列为脊柱硬膜内肿瘤的鉴别诊断之一。
