Intracranial metastasis from synovial sarcoma.

Area of Science:

• Oncology
• Orthopedic Oncology
• Pathology

Background:

• Synovial sarcoma is a soft tissue sarcoma often affecting young adults, frequently misdiagnosed and sometimes presenting after trauma.
• It typically occurs near large joints, with lung and lymph nodes being common metastasis sites.
• Skeletal and cranial metastases are rare, with cranial involvement documented in only two previous cases.

Observation:

• A 17-year-old male presented with concurrent, growing masses in the skull and thigh.
• Biopsies confirmed synovial sarcoma in both the cranial and thigh lesions.
• Staging scans ruled out distant metastasis to the lungs, abdomen, pelvis, or skeleton.

Findings:

• This case represents a rare occurrence of synchronous, multifocal primary synovial sarcoma.
• It challenges the typical presentation and metastatic patterns of synovial sarcoma.
• The cranial mass was confirmed as a primary tumor, not a metastasis.

Implications:

• Highlights the diagnostic challenge in differentiating multiple primary soft tissue sarcomas from metastasis.
• Suggests that synovial sarcoma can present as multifocal primary tumors, including cranial sites.
• Emphasizes the need for thorough evaluation in cases of suspected soft tissue sarcoma with unusual presentations.