Bates Taylor, Kao Erica, Alderete Joseph, Lybeck Dustin
Department of Orthopaedic Surgery, San Antonio Military Medical Center, JBSA-Fort Sam Houston, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Ft. Sam Houston TX, 78219.
Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, TX.
Mil Med. 2020 Sep 18;185(9-10):e1864-e1868. doi: 10.1093/milmed/usaa048.
Synovial Sarcoma is a soft tissue sarcoma with a propensity to imitate a benign neoplasm. It is most common in males 15-40 years old, typically presents as a slow growing painful mass, and often arises insidiously without alarm to the patient. Three patients with synovial sarcomas who had each undergone an index procedure to treat a small presumedly benign mass that was later identified as synovial sarcoma were reviewed. All three patients required re-excision of the tumor and tumor bed and are currently undergoing routine surveillance. All patients exhibited the classic translocation t(X;18) (p11.2; q11.2) and all were of the monophasic type. All lesions were less than 35 mm in greatest longitudinal dimension on MRI. None have experienced recurrences of synovial sarcoma to date. Healthcare providers should be aware of the synovial sarcoma's propensity to masquerade as a benign disease and the characteristic clinical and radiological findings. We advocate for a low threshold to obtain advanced imaging and consideration of a tissue diagnosis prior to excision. A referral to an orthopedic oncologist should be considered and biopsy should only be performed where the definitive treatment will take place if malignancy is identified.
滑膜肉瘤是一种倾向于模仿良性肿瘤的软组织肉瘤。它在15至40岁男性中最为常见，通常表现为生长缓慢的疼痛性肿块，且往往隐匿发生，患者无警觉。回顾了三名滑膜肉瘤患者，他们均接受了首次手术以治疗一个起初被认为是良性的小肿块，该肿块后来被确诊为滑膜肉瘤。所有三名患者均需要对肿瘤及肿瘤床进行再次切除，目前正在接受常规监测。所有患者均表现出典型的t(X;18)(p11.2;q11.2)易位，且均为单相型。MRI上所有病灶的最大纵向尺寸均小于35毫米。迄今为止，无一例出现滑膜肉瘤复发。医疗服务提供者应意识到滑膜肉瘤有伪装成良性疾病的倾向以及其特征性的临床和影像学表现。我们主张在切除前采用低门槛进行高级影像学检查并考虑组织诊断。应考虑转诊至骨肿瘤学家处，仅在确定为恶性肿瘤且将进行确定性治疗的部位进行活检。
