Synovial Sarcoma of the Hand: A Case Report and Literature Review on a Significant Challenge in Treatment

Soft tissue sarcomas (STS) of the hand are extremely uncommon, with synovial sarcomas being even rarer. Despite their small size at presentation, hand sarcomas can indeed be aggressive and may result in significant morbidity and mortality if not effectively managed. A considerable proportion of these tumors are treated by unplanned excision before referral to a specialist oncological center. Additionally, hand sarcomas can mimic benign lesions, leading to misinterpretation and delayed diagnosis. To address these challenges, it is essential to thoroughly investigate all atypical soft tissue masses arising in the hand. Surgery is indeed considered the primary treatment for STS of the hand. However, achieving wide surgical margins can be particularly challenging in this area due to the intricate anatomy and proximity of tumors to vital structures within the hand. Adjuvant radiotherapy plays a crucial role in achieving local tumor control by targeting microscopic tumor cells near the surgical bed. This approach allows for a planned close margin excision along critical structures, which is essential for reducing the risk of tumor recurrence while preserving hand function. The role of adjuvant chemotherapy for synovial sarcoma of the hand is controversial and still a matter of intense debate. Distant metastasis and local recurrence are common in synovial sarcoma cases. They mostly metastasize to the lungs, followed by lymph nodes, bones, and the liver. Multidisciplinary discussions involving surgeons, medical oncologists, radiation oncologists, and other specialists are crucial in making informed decisions about the most appropriate treatment approach for each individual patient with STS of the hand. This collaborative approach ensures that the chosen treatment plan optimizes both oncological outcomes and the patient's overall quality of life.