Shah Wali Umer, Shujaat Syeda Dania, Ullah Naseeb, Mansoor Salman
Pakistan Institute of Medical Sciences (PIMS), Islamabad.
University of Oklahoma Health Sciences Center, Oklahoma, USA.
J Pak Med Assoc. 2018 Jul;68(7):1100-1104.
Synovial sarcoma is a soft-tissue sarcoma. Its involvement of the spine is extremely rare. We report a 40 year old male who presented with shoulder pain and progressive weakness in all four limbs for six months with a visible, slowly growing bulge in his upper back. On examination he had quadriparesis and diffuse sensory deficit. MRI of the cervical spine showed a large soft tissue mass, iso to hypointense, extending into the neural canal, compressing the cord. The mass had a few internal areas of contrast enhancement with extension into the right paraspinal regions involving the vertebral bodies. Sub-periosteal spine dissection was done. Tumour was primarily extradural, involving and extending from paraspinal soft tissues to the posterior arches, laminae and spinous processes of the verteberae, with their destruction. Gross radical removal of the visible mass was done, followed by three cycles of radiation therapy. Excisional biopsy showed synovial sarcoma TYPE II. In conclusion, synovial sarcomas should be kept in the differentials of a mass arising in spinal axis.
滑膜肉瘤是一种软组织肉瘤。它累及脊柱极为罕见。我们报告一例40岁男性，因肩部疼痛和四肢进行性无力6个月就诊，其上部背部可见一个缓慢生长的肿块。检查发现他有四肢瘫和弥漫性感觉障碍。颈椎MRI显示一个大的软组织肿块，等信号至低信号，延伸至椎管，压迫脊髓。肿块有几个内部强化区域，并延伸至右侧椎旁区域累及椎体。进行了椎板下脊柱剥离术。肿瘤主要位于硬膜外，累及椎旁软组织并从其延伸至椎体的后弓、椎板和棘突，并导致其破坏。肉眼下彻底切除可见肿块，随后进行三个周期的放射治疗。切除活检显示为II型滑膜肉瘤。总之，滑膜肉瘤应列入脊柱轴上出现肿块的鉴别诊断中。
