Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 11, 2018
SYNOVIAL SARCOMA
- Background
- Synovial sarcoma (SS) is an uncommon malignant mesenchymal tumor;
- Young adults and adolescents are most often affected;
- The spine is an unusual location for a SS; the cervical spine is an even more rare location.
- Clinical Presentation
- Symptoms and signs of spinal SS depend on its location;
- Local pain, radicular pain, paresthesia, and weakness of limbs are common in spinal SS.
- Key Diagnostic Features
- Typical cross-sectional imaging appearances of SS of extremities include a multilobulated lesion and marked heterogeneity with hemorrhage, and internal septae;
- Spinal SS have similar image presentations to neurogenic tumors, as a dumbbell-shaped tumor at neural foramina and/or paraspinal growth with ether adjacent bone erosion or destruction;
- Contrast enhancement could be homogeneous or heterogeneous.
- Differential Diagnosis
- Benign peripheral nerve sheath tumor: The tumor tends to be homogeneous and there is no bone erosion;
- Malignant peripheral nerve sheath tumor: Central necrosis and bone destruction are more common, and there are imaging findings that overlap, so a definitive diagnosis requires a biopsy;
- Metastasis: Foraminal location is an un common site, and may be due to perineural spread, so careful assessment of the extravertebral findings may reveal the primary lesion;
- Lymphoma: Usually demonstrates homogeneous signal and enhancement pattern, may encase adjacent vessels, may involve/extend from adjacent bony structures.
- Treatment
- Surgery and adjuvant radiotherapy.
