Clin Orthop Surg.  2015 Jun;7(2):254-260. 10.4055/cios.2015.7.2.254.

Distinct Clinical Characteristics of Unplanned Excision in Synovial Sarcoma

• Choi ES
• Han I
• Cho HS
• Kang HG
• Kim JH
• Kim HS

• KMID: 2164553
• DOI: http://doi.org/10.4055/cios.2015.7.2.254

Abstract

BACKGROUND
We aimed to describe the clinical characteristics and outcomes of unplanned excisions of synovial sarcomas.
METHODS
In total, 90 patients with synovial sarcomas in the extremities were retrospectively reviewed. Patients were divided into unplanned excision (n = 38) and planned excision (n = 52) groups. The average follow-up period was 6 years. The clinicopathological characteristics and oncologic outcomes were compared.
RESULTS
The unplanned excision group showed longer duration of symptoms before diagnosis (p = 0.023), smaller lesion dimensions (p = 0.001), superficial location (p = 0.049), and predilection in the upper extremities (p = 0.037). Synovial sarcomas were most commonly misdiagnosed as neurogenic tumors (56%) in the upper extremities or as cystic masses (47%) in the lower extremities. Oncological outcomes, including disease-specific survival, metastasis-free survival, or local recurrence were not significantly different between the 2 groups (p = 0.159, p = 0.444, and p = 0.335, respectively). Repeated unplanned excision (p = 0.012) and delayed re-excision (p = 0.038) were significant risk factors for local recurrence in the unplanned excision group.
CONCLUSIONS
Synovial sarcomas treated with unplanned excision had distinct characteristics. These findings are important for developing diagnostic and therapeutic strategies for synovial sarcoma.

Keyword

Synovial sarcoma; Oncologic outcomes; Magnetic resonance imaging

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Male
Middle Aged
Retrospective Studies
Sarcoma, Synovial/*diagnosis/*surgery
Soft Tissue Neoplasms/*diagnosis/*surgery
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 (A) The axial view of T1-weighted magnetic resonance imaging (MRI) scan shows a multiseptated cystic lesion in the popliteal area. (B) The T2-weighted MRI scan shows internal fluid-fluid level suggesting hemorrhagic component. (C) The mass was not enhanced on postcontrast T1-weighted MRI scan.

• 

  Fig. 2 (A) The coronal view of T1-weighted magnetic resonance imaging (MRI) scan shows a round lesion besides coracobrachialis muscle. (B) The axial view of postcontrast T1-weighted fat suppression MRI scan shows well-enhancing mass. (C) The T2-weighted MRI scan suggests the mass arises from the median nerve.

• 

  Fig. 3 Kaplan-Meier analyses of oncologic outcomes between the planned excision group and unplanned excision group. No statistical difference was observed between the groups: (A) disease-specific survival (p = 0.159), (B) metastasis-free survival (p = 0.335), and (C) local recurrence-free survival (p = 0.444).

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