Management of synovial sarkoma: a case report

Abstract

INTRODUCTION Synovial sarcoma is a non-specific heterogenous malignant cancer of soft tissue sarcomas group, which is caused by changes in chromosomes. There are three morphologic subtypes: monophasic, biphasic, and poorly differentiated. It is slow-growing, most commonly found in periarticular soft tissue of the extremities. It affects both sexes equally, median is 39 years old. To diagnose synovial sarcoma, MRI and biopsy must be done. Treatment plan consists of surgical excision with negative margins, additionally radiotherapy or/and chemotherapy can be used. Five-year survival rate is between 59 and 75%, there is a chance of late recurrence, which usually metastasize to the lungs. CASE PRESENTATION 47-year-old man noticed a painful growing derivative in the right ankle area. Intralesional resection has been done without biopsy in community hospital. After six months, in February 2021, patient came to our hospital. Palpable mass in the right ankle area was found during the inspection, except pain, no other symptoms such as atrophy of muscle, fever or weight loss were found. The patient was consulted by an orthopaedic oncologist due to a suspicion for a malignant tumor. A biopsy was performed, and the patient was diagnosed with biphasic high grade (G3) synovial sarcoma. Pulmonary and abdominal CT were normal. Multidisciplinary council decided to start neoadjuvant chemotherapy with doxorubicin and iphosphamid to reduce the size of the tumor. In June 2021, control MRI was performed, which has shown no response to chemotherapy. Transtibial amputation was performed due to soft tissue contamination of tumor by earlier intralesional resection. No complications were found, patient was discharged home. During follow-up consultations every 3-6 months no finds of local recurrence and metastasis were found. DISCUSSIONS This case report demonstrates necessity of early diagnose of synovial sarcoma to avoid amputation. Suspected tumor must be examined by orthopaedic oncologist, and biopsy must be done for an accurate diagnosis.