Radiological manifestations of synovial sarcoma

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Synovial sarcoma (SS) is a rare soft-tissue sarcoma (STS), most common in children (30%) and frequently affecting the knee, ankle, and foot.
• SS often presents with slow growth and an earlier age of diagnosis (adolescents/young adults), leading to frequent misdiagnosis as benign conditions.
• Distinguishing SS from other STS is challenging due to overlapping imaging features, making accurate diagnosis critical.

Purpose of the Study:

• To highlight key diagnostic characteristics of synovial sarcoma.
• To emphasize the role of radiological imaging, nuclear medicine, and pathological studies in SS diagnosis.
• To illustrate diagnostic features using case examples from the authors' center.

Main Methods:

• Review of diagnostic characteristics of synovial sarcoma.
• Emphasis on Magnetic Resonance Imaging (MRI) for characterizing SS.
• Discussion of pathological confirmation via translocation t(x;18)(p11;q11) using Fluorescence In Situ Hybridization (FISH).

Main Results:

• Synovial sarcoma shares imaging features with other STS, necessitating advanced diagnostic techniques.
• MRI plays a crucial role in the characterization of SS.
• The pathognomonic translocation t(x;18)(p11;q11), confirmed by FISH, is essential for definitive diagnosis.

Conclusions:

• Accurate diagnosis of synovial sarcoma requires a multidisciplinary approach integrating imaging and pathology.
• Radiological imaging, particularly MRI, is vital for initial assessment and characterization.
• Pathological confirmation, including genetic analysis (FISH), remains the gold standard for definitive SS diagnosis.