Clin Orthop Surg.  2017 Dec;9(4):547-552. 10.4055/cios.2017.9.4.547.

Synovial Sarcoma Complicating Total Knee Arthroplasty

• Savvidou O
• Chloros GD
• Koutsouradis P
• Megaloikonomos PD
• Skarpidi E
• Papagelopoulos PJ

• KMID: 2412259
• DOI: http://doi.org/10.4055/cios.2017.9.4.547

Abstract

Synovial sarcoma is a relatively common periarticular soft tissue malignancy, occurring mostly in the extremities of younger patients. Occasionally, diversity in its clinical features may lead to misdiagnosis and inappropriate management. The authors report herein a unique case of a patient who underwent a primary total knee arthroplasty to treat osteoarthritis. During the operation, a mass was discovered but was attributed to synovitis. Biopsy revealed a rare intra-articular synovial sarcoma. The patient underwent reoperation with wide excision and endoprosthesis placement and is disease-free at the 8-year follow-up.

Keyword

Osteoarthritis; Knee; Sarcoma; Synovial; Diagnostic errors

MeSH Terms

Aged
*Arthroplasty, Replacement, Knee/instrumentation
Female
Humans
Incidental Findings
Osteoarthritis/complications/surgery
Reoperation
Sarcoma, Synovial/complications/pathology/*surgery
Soft Tissue Neoplasms/complications/pathology/*surgery

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) radiographs of the right knee demonstrating osteoarthritic changes with joint narrowing and sclerosis.

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  Fig. 2 Anteroposterior (A) and lateral (B) radiographs showing right total knee arthroplasty.

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  Fig. 3 (A) Biphasic tumor with epithelioid and spindle cell morphology (H&E). (B) Strong keratin staining in the epithelioid component. (C) CK-19 positive expression in the epithelioid component. (D) S100 focal expression in the spindle cell component (all panels, ×200).

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  Fig. 4 Axial view of the postoperative T1 magnetic resonance imaging of the right knee, demonstrating a large soft-tissue mass on the anterolateral side of the distal thigh.

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  Fig. 5 (A) Intraoperative picture showing the wide fusiform skin incision procedure (wide extra-articular knee resection). (B, C) Wide extra-articular knee resection. (D) Intraoperative picture showing reconstruction of the residual bone defect using a modular knee endoprosthesis (METS, Stanmore Implants).

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  Fig. 6 (A) Intraoperative picture of the gastrocnemius rotational flap (arrow) that was used to manage wound closure complications. (B) Surgical wound 1 month postoperatively.

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  Fig. 7 Anteroposterior (A) and lateral (B) X-rays of the right knee with a megaprosthesis at the 8-year follow-up, showing no evidence of implant loosening.

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