Synovial sarcoma of foot
Presentation:
Right foot dorsum nodular lesion - on fibular aspect - Near 5th metatarsal base - Few mths.
Patient Data:
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Well-defined soft tissue lesion is seen in region of interest. Size - 19 x 12 x 10 mm
Location - Abutting peroneus logngus tendon.Lesion encirlces more than 180 but less than 360 degree of tendon. Seperate from bone and tendon.
Dynemic scan - Free movements of tendon was noted from the lesion.
Morphology - Solid - Multiple tiny echogenic foci - ? calcification. - Large lobulation present.
Dopplar - Arterial as well as venous flow noted.- Flow within lesion and in wall.
Case Discussion:
Most of the foot masses are benign tumor or tumor like conditions.
Differencials - Ganglion, bursitis, foreign body granuloma, pigmented vilonodular synovitis, giant cell tumor of tendon sheath, haemangioma.
2 maligment lesions should be included - Synovial sarcoma and maligment malenoma.
After US scannig, two possibilities were reported
1 - Giant cell tumor of tendon sheath because lesion of nearly encircling peroneus tendon.
2 - Haemangioma - Due to high vascularity and some echogenic foci - ? calcification.
Radiograph was done after US, to check for calcification, but it could not be seen.
Lesion was removed after 3 days. Surgeon discarded possibility of haemangioma of gross examination.
1st biopsy report was suspicious for malignency. Further evalution of slide was done by ? immunohistochemistry.
Final biopsy diagnosis - Synovial sarcoma.
References:
- Ultrasound of the Musculoskeletal System by Stefano Bianchi , Carlo Martinoli.
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