Synovial sarcoma - hand

Case contributed by Dr Amr Farouk

Presentation

Presenting with hand swelling of a few months duration.

Patient Data

Age: 65 years
Gender: Female
X-ray

Near total erosion of the fourth metacarpal bone with soft tissue tumefaction widening the space between the third and fifth metacarpal bone extending distally in-between the index and ring fingers.

MRI

A lobulated ill-defined soft tissue mass is seen at the left hand mainly volar aspect and to less extent dorsal aspect. The mass is seen eroding the fourth metacarpal bone for a 3.6 cm segment. The mass is seen eliciting low to intermediate signal on T1 WIs and bright signal on T2 and STIR WIs with small cystic areas of fluid like signal within "bowl of grapes". It shows vivid heterogeneous enhancement at post contrast T1 WIs. It measures about 7.1 x 5.1 x 4.6 cm at its maximal CC, AP and T dimensions respectively. The mass is seen breaching from volar aspect to dorsal aspect via the third inter-meta-carpal space widening and extending distally between the proximal phalanges of the third and fourth fingers spacing between them.  Furthermore, the lesion is seen compressing and inseparable from the flexor and extensor tendons of the third and fourth fingers.

Case Discussion

Neoplastic soft tissue mass centered on soft tissues of the hand and destroying adjacent bone representing a malignant neoplastic process. Biopsy was done revealing synovial sacroma (biphasic).

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Case information

rID: 63840
Published: 9th Nov 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: National cancer institute, Cairo, Egypt

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