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Open Access Highly Accessed Case report

A 63-year-old woman presenting with a synovial sarcoma of the hand: a case report

Diogo Casal1, Ana Isabel Ribeiro2, Manuela Mafra3, Conceição Azeda4, Carlos Mavioso4, Maria Manuel Mendes4 and Maria Manuel Mouzinho456*

Author Affiliations

1 Plastic and Reconstructive Surgery Resident, São José Hospital, Lisbon, Portugal

2 Pathology Resident, São José Hospital, Lisbon, Portugal

3 Pathology Senior Consultant, São José Hospital, Lisbon, Portugal

4 Plastic and Reconstructive Surgery Senior Consultant, São José Hospital, Lisbon, Portugal

5 Head of the Hand Surgery Clinic, São José Hospital, Lisbon, Portugal

6 Plastic and Reconstructive Surgery Department, Hospital de São José, Rua José António Serrano, 1150-199, Lisbon, Portugal

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Journal of Medical Case Reports 2012, 6:385  doi:10.1186/1752-1947-6-385

Published: 13 November 2012

Abstract

Introduction

Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma.

Case presentation

We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented.

Conclusion

Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.

Keywords:
Synovial sarcoma; Hand; Surgery; Malignant tumor