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Synovial sarcoma presenting as an intra-articular mass in a pediatric patient: a case report
Omar A Al-Mohrej1, Saeed A Al-Jarallah2, Hamad H Al-Dakhil Allah2
1Department of Orthopaedics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. mohrejo@gmail.com.
Insights
Synovial sarcoma (SS) is a rare cancer. Early misdiagnosis can delay treatment, highlighting the need for comprehensive evaluation of soft tissue masses in children.
Area of Science:
- Oncology
- Pediatric Pathology
- Surgical Pathology
Background:
- Synovial sarcoma (SS) is a recognized sarcoma in pediatric and adult populations.
- Delayed diagnosis and treatment are frequent challenges in SS cases.
- SS may be surgically removed before accurate diagnosis is established.
Observation:
- A 4-year-old boy presented with left knee pain and restricted flexion.
- Initial diagnosis was osteochondromatosis, followed by surgical excision.
- Initial histopathology suggested fibrous histiocytoma.
Findings:
- Re-evaluation at King Faisal Specialist Hospital Research Center revealed a sub-synovial monomorphic spindle cell sarcoma.
- The tumor was a well-circumscribed nodule within the synovium.
- Fluorescence in situ hybridization (FISH) confirmed the diagnosis of synovial sarcoma.
Implications:
- This case underscores the importance of considering synovial sarcoma in the differential diagnosis of pediatric soft tissue knee masses.
- Accurate histopathological analysis and advanced techniques like FISH are crucial for definitive diagnosis.
- Comprehensive differential diagnosis is essential for appropriate surgical planning and patient management.
Background:
Synovial sarcoma (SS) is one of the reported sarcomas in the pediatric and adult populations. Delay in diagnosis and treatment is common in SS cases. SS may be excised before the correct diagnosis is made.
Case Presentation:
we present a case involving a 4-year-old boy who visited our service with complaints of left knee pain and limited knee flexion. Initially, the child was diagnosed with osteochondromatosis. Surgical excision was opted, and initial histopathological examination revealed a fibrous histiocytoma. The slide and blocks were then brought to the King Faisal Specialist Hospital Research Center (KFSH&RC) and histopathologic analysis has shown a well-circumscribed nodule in the synovium with a sub-synovial monomorphic spindle cell sarcoma, confirmed by fluorescence in situ hybridization (FISH).
Conclusions:
Therefore, we strongly recommend considering all differential diagnoses for soft-tissue masses when planning surgical management.
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