Synovial sarcoma mimicking haemophilic pseudotumour

Area of Science:

• Orthopaedic Surgery
• Oncology
• Haematology

Background:

• Haemophilia A management often involves addressing bleeding complications like intramuscular hematomas.
• Soft tissue swellings in haemophilia patients are typically attributed to bleeding events.

Observation:

• A 36-year-old male with haemophilia A presented with acute, atraumatic soft tissue swelling in the right thigh.
• Initial MRI findings were consistent with a typical intramuscular hematoma in haemophilia.
• Open biopsy revealed a synovial cell sarcoma.

Findings:

• The clinical presentation and initial MRI findings were nonspecific and mimicked a bleeding pseudotumor.
• Synovial cell sarcoma is a rare but critical differential diagnosis in atraumatic soft tissue masses in haemophilic patients.
• The absence of trauma is a key indicator that the swelling may represent hemorrhage into a tumor.

Implications:

• Clinicians must consider the possibility of underlying tumors, such as sarcomas, in haemophilic patients presenting with atraumatic soft tissue swelling.
• Early and accurate diagnosis is crucial for appropriate oncological and orthopaedic management.
• This case highlights the importance of a high index of suspicion for rare conditions even in the context of common bleeding disorders.