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Synovial sarcoma is a malignant tumor originating from soft tissues of joints, synovium, and tendon sheath synovium. The major joints of the limbs are commonly affected, but it can also occur on the muscle membranes and fascia of the forearm, thigh, and lumbar back. The main clinical symptoms are local swelling, lumps, pain, and limited mobility. Surgical treatment is the main approach.
Synovial sarcoma is a painless mass near the joint, and patients may experience swelling or lumps around the joint. The mass can extend along the soft tissue to the entire forearm. There may be venous distension on the surface of the lump skin. The texture of the lump is moderate, and it can also be slightly hard or soft. There may be varying degrees of pain, hidden pain, or dull pain, followed by severe pain in the later stages, with significant nighttime pain. Some patients have limited local limb movement. Lesions are most common near the joints of the limbs, with the knee joint being the most common. They are also common in the wrist joint, elbow joint, shoulder joint, soft tissue of the forearm, fingers, feet, and other areas. They can also occur on tendons and fascia.
| Symptoms | Descriptions |
| X-ray examination | (1) Not all soft tissue masses that are clinically palpable can be displayed on X-rays. Some show local soft tissue swelling, while others present with soft tissue masses. The density of the mass is slightly higher than that of adjacent soft tissue, with varying sizes, and larger ones have the characteristic of growing across joints. (2) 30% of soft tissue masses show amorphous and irregular calcifications. The causes of calcification may be related to factors such as bleeding, infection, necrosis, and cartilage calcification. The degree of calcification is related to the malignancy of the tumor, and the less calcification, the higher the malignancy. (3) Skeletal changes can result in varying degrees of bone compression, defects, or osteolytic destruction, such as osteoporosis, bone atrophy deformities, cystic bone defects, bone erosion, osteolytic destruction, joint changes, etc. Early manifestations include mild osteoporosis, followed by compressive bone atrophy, thinning, or cystic defects, which further develop into bone destruction. Bone destruction is mostly irregular and can also be cystic, and those who cross joints can invade multiple bones. The patient's joints often remain unchanged and may occasionally invade the joints, causing widening of the joint space or the appearance of soft tissue masses, as well as joint effusion. (4) Periosteal reactions can present as parallel, lace like, or needle like reactions. Some may not have a clear periosteal reaction, but adjacent cortical bone may show spike like protrusions and Codman's triangle. |
| Arteriography | It has great diagnostic value for synovial sarcoma. Angiography can show the characteristics of newly formed capillaries, vascular lakes, and other malignant tumors at the mass site. It can also prevent surgery from damaging large blood vessels or perform intra-arterial chemotherapy. |
Synovial sarcoma is more common in adults and is more likely to occur in the joints of the limbs. It belongs to malignant tumors. If it occurs around the joints, the possibility of synovial sarcoma should be considered, and CT and isotope scanning should be performed to clarify the scope and overall condition. Diagnosis relies on biopsy pathology reports. The differentiation of synovial sarcoma mainly relies on pathological examination, and should be distinguished from adenocarcinoma, soft tissue acinar sarcoma, fibrosarcoma, leiomyosarcoma, and schwannoma.
The treatment of synovial sarcoma is mainly surgical resection, aiming for extensive resection. If there is vascular invasion, the blood vessels need to be removed together. Incomplete resection results in a high local recurrence rate. This disease is prone to metastasize to the lungs through blood circulation, and there is also lymphatic metastasis. For those with large draining lymph nodes, lymph node dissection should be performed during tumor resection. The 5-year survival rate of this disease is between 20% and 50%. For those who have incomplete local resection, radiotherapy can be supplemented. Currently, the effectiveness of chemotherapy is uncertain. Synovial sarcoma is a highly malignant tumor, with varying degrees of severity and relatively poor prognosis in late stages due to distant metastasis. Medications have no significant effect on synovial sarcoma, chemotherapy drugs are only used for postoperative adjuvant therapy, and antibiotics are used after surgery to prevent infection.
| Treatment | Descriptions |
| Surgery | If synovial sarcoma does not receive adjuvant therapy or the lesion does not respond to adjuvant therapy, radical surgical treatment is required. If the lesion responds to preoperative radiotherapy and/or chemotherapy, the recurrence rate after local resection is less than 10%. For larger lesions located in the proximal limbs and around the trunk in the deep region, even if there is a satisfactory response to adjuvant therapy, the local recurrence rate is still high after edge resection. Patients who are satisfied with the response to neoadjuvant therapy for small and superficial lesions located at the distal end of the limb have a low risk of recurrence. |
| Chemotherapy | Adjuvant chemotherapy can occasionally produce good results, allowing patients who need amputation to undergo limb salvage surgery. Postoperative chemotherapy, as the ultimate treatment for local lymph node and/or distant metastases, only has a response in some patients, but cannot achieve immediate or long-term control of the lesion. |
| Radiotherapy | Most synovial sarcomas have a satisfactory response to adjuvant radiotherapy, and when radiotherapy is used as the ultimate or palliative treatment, the disease can usually be relieved. |
Synovial sarcoma can metastasize to both regional lymph nodes and distant lungs, and incomplete resection has a high recurrence rate. This disease tends to metastasize to the lungs, and lymph node metastasis is also common, with an incidence rate of about 20%. The 5-year survival rate of patients is 20% to 50%.
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