Synovial sarcoma

Case contributed by Dr Yasser Asiri


Left calf swelling, for assessment.

Patient Data

Age: 30 years
Gender: Female

Large complex cystic soft tissue mass involving the posterior medial aspect of the leg. The lesion demonstrates mixed high and intermediate signal intensity on T2 and a central hemorrhagic component of high T1 images.  Intralesional fluid-fluid levels are seen giving the appearance of "bowl of grapes". The mass is located at the expected location of pes anserinus bursa. There is no bony or joint extension.

The differential diagnosis would include synovial sarcoma or angiomatoid fibrous histiocytoma (pleomorphic undifferentiated sarcoma).

Case Discussion

MRI features of synovial sarcoma are of a well-defined heterogeneous soft tissue mass around joint, more specifically, near to the tendon, bursa or around the joint capsule. The "triple sign" is classically described in synovial sarcoma which is a mixture of high, intermediate and low signal regions within the mass seen on T2 weighted images. Another helpful sign is "bowl of grapes", which describes the appearance of multiple fluid-fluid levels in the mass. Bony erosions or secondary joint space invasion can occur 1.

PlayAdd to Share

Case information

rID: 64935
Published: 21st Dec 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.