Synovial Sarcoma is a malignant, soft-tissue tumour representing approximately 10% of all soft-tissue sarcomas. It is said to be juxta-articular, that is situated close to or in the vicinity of a joint.
Synovial sarcoma was first reported in the year 1893 and named after its microscopic resemblance to normal synovium. The synovial membrane or synovium is a specialized kind of connective tissue that lines the inner parts of capsules of synovial joints and sheaths of tendons. It is in contact with the synovial fluid lubricant and its function is lubrication and easy movement.
Alarm bells for a synovial sarcoma can be triggered when a young adult or adolescent is seen with a slowly growing, calcified soft-tissue mass around a joint.
Where does synovial sarcoma occur ?
It is thought to originate from primitive mesenchymal cells that then go through differentiation to look like synovial cells.
They typically affect the extremities, arising from joint capsules, tendons, tendon sheets and bursal structures. It is important to note that though the tumour cells resemble the synovium, they typically crop up beyond the boundaries of the joint capsule. This basically means that though synovial sarcomas are usually found in close association with joint structures, joint involvement is rare.
The neoplasm usually occurs in close proximity to large joints of the extremities, predominantly around the knee, followed by the ankle, elbow and shoulder.
What are the Clinical features of synovial sarcoma occur ?
Synovial sarcoma is typically prevalent in adolescents and/or young adults between 15 and 40 years of age.
Patients come with the complaint of a peri-articular (surrounding the joint), palpable, soft, slowly-growing, deep-seated swelling or mass that is commonly painful or tenderness.
The duration of symptoms can range from weeks to decades, with an average duration of 2–4 years.
How is synovial sarcoma occur diagnosed ?
Typical radiographic features on plain X-ray films include a soft-tissue mass, surrounding or near the joint. An associated bony reaction can be seen in a few of the cases.
In the advanced imaging techniques, the Computed tomography (CT) scanning shows a soft-tissue mass with or without calcifications and involvement of bone. CT is still recommended as the best imaging method for assessing the local extent of the primary tumour and is a useful tool in the planning of appropriate therapy as well as evaluation of tumour response to ongoing treatment.
The MRI scanning is taken for local staging and assessing the extent of the disease.
Even after radiography, biopsy is always mandatory and necessary for the final diagnosis. Nevertheless, radiologic findings and location of the tumour also point to the diagnosis of Synovial Sarcoma.
Histologically there are two types of synovial sarcomas,that is either biphasic (dual cell population) or monophasic (single cell population). The biphasic type is an admixture of epithelial cells and spindle cells. The monophasic type is composed of either only epithelial cells or spindle cells.
How are synovial sarcoma treated ?
- First the tumours have to be staged. This has to be done both locally and systemically, seeing the spread of the tumour.
- Secondly, biopsy has to be done to confirm the synovial sarcoma.
- The current treatment of choice is complete surgery with or without radiotherapy. Adjuvant radiotherapy to remove microscopic disease after surgery is useful.
- The use of chemotherapy is controversial.
How does a synovial sarcoma behave ?
Favourable factors include young age of the patient (15 years or younger), tumour size which is smaller than 5 cm, and finally, distal (farther away from body) rather than proximal location (closer to the body) in the extremities.
Though the Synovial sarcoma is slow-growing, it is a high-grade malignant neoplasm with extensive metastatic potential.
Metastasis is seen in roughly a quarter of patients at the time of initial diagnosis. It mainly is known to affect the lungs then, to a lesser degree, the lymph nodes, bone and hardly ever the liver or the brain.
What is the care to be taken after the removal of a synovial sarcoma ?
Consult an Oncologist. Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
