Which radiology findings are characteristic of synovial sarcoma?

Updated: Mar 02, 2019
  • Author: Michael J Duh, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

Radiography is often the initial study obtained for the evaluation of synovial sarcoma. In 50% of patients with synovial sarcoma, radiographic findings are interpreted as normal (as potentially could occur with the image below). If an abnormality is present, the radiograph may reveal a well-defined, round or lobulated soft-tissue mass that averages approximately 8 cm in its largest dimension. [6]

Lateral radiograph of the femur in a 45-year-old m Lateral radiograph of the femur in a 45-year-old man who presented with a large, right midthigh mass. This radiograph is remarkable only for a subtle soft-tissue prominence on the anterior aspect of the thigh. No calcifications are depicted.

Approximately 30% of patients have calcifications that are detectable radiographically (as in the images below). The calcifications may be focal or spread throughout most of the tumor, and they may appear fine, stippled, or opaque.

Lateral radiograph of the foot in a 60-year-old ma Lateral radiograph of the foot in a 60-year-old man who presented with a mass on the dorsum of his left foot. The radiograph shows a soft-tissue mass that is anterior to the talus and without obvious underlying bone erosion. Subtle faint calcifications are seen within the mass.
Anteroposterior radiograph of the hip in a patient Anteroposterior radiograph of the hip in a patient who presented with a mass in the region of the left hip. Opaque, masslike calcifications overlying the femoral neck and inferior pubic ramus are seen.

Uncommonly, tumors can erode bone. Adjacent periosteal reaction can be seen in as many as 20% of patients. Distant metastases to bone are usually of the lytic and/or mixed variety.

When the neoplasm is near a joint and causes limitation of movement, periarticular osteoporosis may be seen.


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