Synovial sarcoma of foot

Case contributed by Dr Maulik S Patel

Presentation

Right foot dorsum nodular lesion - on fibular aspect - Near 5th metatarsal base - Few mths.

Patient Data

Age: 35 - 40 yrs
Gender: Female
Modality: Ultrasound

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Modality: X-ray

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.

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Case Information

rID: 18150
Case created: 14th Jun 2012
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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