.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Primary Tibial Synovial Sarcoma: Uncommon Tumour on Uncommon Site –Case Reports
Keywords:
Synovial sarcoma, tibia, chemotherapy, resection, fibular graft.Abstract
ABSTRACT
Objective:To report the clinical characteristic of primary tibial synovial sarcoma, in terms of aggressiveness, local spread/ metastasis, surgical procedures and final outcome.
Methods:3 case reports conducted and diagnosed in last 10 years were included and examine clinically as well radiologically. and ultimate surgical procedures performed and post operative follow up were studied and recorded. Patients diagnosed and procedures performed at other centre were excluded. All three patients underwent wide surgical excision and reconstruction with non vascularized fibular graft. Clinical and radio graphical follow up of 3 years done to see any recurrence and other complications.
Results: three cases of primary tibial synovial sarcoma diagnosed in study period, all of them were female and in teen age, 2 were of 17 years and one 19 years old. One case of 19 years female present with history of 1 year of swelling and pain of leg.Second and third case of 17 years age present with history of 6 and 9 months respectively of mass and pain in leg respectively. All cases were examined, investigated and biopsy done showed synovial sarcoma, followed by Wide local excision done, non-vascularized graft from fibula of opposite leg placed and anti rotatory screw applied in first case and Non-vascularized graft from fibula of opposite leg and fixation with inter-medullary k-wire and butteress T plate done in second and third case. Wound covered with rotational flap in all three cases followed by chemotherapy. No complication or recurrence noted in 3 years follow-up.
Conclusion: Primary Synovial sarcoma of bone is rare tumour and rarely occurs at tibia, with a tendency to occur in young adults and chemotherapy sensitivity. These case reports shows good outcome in management of synovial sarcoma with wide local excision and chemotherapy.
References
2. M. Haldar, R. L. Randall, and M. R. Capecchi, Synovial sarcoma: from genetics to genetic-based animal modelling. ClinOrthopRelat Res. 2008 Sep; 466(9): 2156–2167..
3. M. Vliet, M. Klien, G. P. Krestin and C. F. Dijke, Softtissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors. EurRadiol. 2009 Jun;19(6):1499-511. doi: 10.1007/s00330-008-1292-3.
4. Kransdorf MJ: Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR, Am J Roentgenol 1995 Jan;164(1): 129–34.
5. Leader M, Patel J, Collins M, Kristin H. Synovial sarcomas. True carcinosarcomas? Cancer 1987 Jun;59(12): 2096–8.
6. Weiss SW, Goldblum JR, Enzinger FM: Enzinger and Weiss’s Soft Tissue Tumors. St. Louis, Mosby Ed 4 2001 pp xiv, 1622..
7. B.W. Scheithauer, A.I. Silva, K. Kattner, J. Seibly, A.M. Oliveira, K. Kovacs, Synovial sarcoma of the sellar region. NeuroOncol. 2007 Oct; 9(4): 454–459. doi: 10.1215/15228517-2007-029.
8. P. O’Donnell, T. C. Diss, J. Whelan, and A. M. Flanagan. Synovial sarcoma with radiological appearances of primitive neuroectodermal tumour/Ewing sarcoma: differentiation by molecular genetic studies. Skeletal Radiolo, 2006 Apr:35(4), 233–239.
9. G. A. Barkan and A. K. El-Naggar, Primary synovial sarcoma of the parotid gland, Ann DiagnPathol, 2004 Aug:8(4), 233–236.
10. K. Anand, A. Khanna, S. K. Sinha, U. Mukherjee, J. S. Walia, A. N. Singh. Pericardial synovial sarcoma, Clinical Oncology, 2003. 15(4) 186–188.
11. Fisher, A. L. Folpe, H. Hashimoto, and S. W. Weiss. Intraabdominal synovial sarcoma: a clinicopathological study.Histopathology. 2004 Sep;45(3):245-53.
12. Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J SurgOncol 2008 Mar;97(4): 314–20.
13. Bernhard M. Speth, Andreas H. Krieg, Andre Kaelin, G. Ulrich Exner, Louis Guillou, Arthur von Hochstetter. et al. Synovial sarcoma in patients under 20 years of age: a multicenter study with a minimum follow-up of 10 years. J Child Orthop 2011 Oct;5(5): 335–42.
14. Spillane AJ, A’Hern R, Judson IR, Fisher C, Thomas JM. Synovial sarcoma: a clinicopathologic, staging, and prognostic assessment. J ClinOncol 2000 Nov;18(22): 3794–803.
15. Wolden SL. Radiation therapy for non-rhabdomyosarcoma soft tissue sarcomas in adolescents and young adults. J PediatrHematolOncol 2005 Apr:27(4): 212.
16. I.J. Cohen, J. Issakov, S. Avigadetal. Synovial sarcoma of bone delineated by spectral karyotyping. Lancet. 1997 Dec 6;350(9092):1679-80.
17. C. Sar and L. Eralp. Surgical treatment of primary tumors of the sacrum. Arch Orthop Trauma Surg. 2002 Apr;122(3):148-55.S. P. Scully, H. T. Temple, and J. M. Harrelson. Synovial sarcoma of the foot and ankle. ClinOrthopRelat Res. 1999 Jul;(364):220-6.
18. W. M. Tilakaratne, Synovial sarcoma of the mandible. J Res Med Sci. 2012 Nov; 17(11): 1082–1085.
19. H. Hiraga, T. Nojima, K. Isu, K. Yamashiro, S. Yamawaki, K. Nagashima. Histological and molecular evidence of synovial sarcoma of bone: a case report. J Bone Joint Surg Am. 1999 Apr;81(4):558-63.
20. Nakajo M1, Ohkubo K, Nandate T, Shirahama H, Yanagi M, Anraku M. et al., Primary synovial sarcoma of the sternum: computed tomography and magnetic resonance imaging ï¬ndings. Radiat Med. 2005 May;23(3):208-12.
21. Fritz C. Eilber, Murray F. Brennan, Frederick R. Eilber, Jeffery J. Eckardt, Stephen R. Grobmyer, Elyn Riedel, MA, et al. Chemotherapy is associated with improved survival in adult patients with primary extremity synovial sarcoma. Ann Surg. 2007 Jul; 246(1): 105–113.
22. R. Jeganathan, R. Davis, L. Wilson, J. McGuigan, and P. Sidhu. Primary mediastinal synovial sarcoma. Ulster Med J. 2007 May; 76(2): 109–111.
23. G. T. Pack and I. M. Ariel, Synovial sarcoma (malignant synovioma). A report of 60 cases, Surgery. 1950 Dec;28(6):1047-84.
24. Lewis JJ1, Antonescu CR, Leung DH, Blumberg D, Healey JH, Woodruff JM. et al. Synovial sarcoma: a multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity. J ClinOncol. 2000 May;18(10):2087-94.
25. W. M. Tilakaratne. Synovial sarcoma of the mandible. J Oral Pathol Med. 2006 Jan;35(1):61-3.
