Synovial sarcoma: a clinicopathological review

Abstract

We have reviewed 20 cases of synovial sarcoma. The main clinical and pathological features of these cases are outlined. Typically these tumours arise in the leg in young adults with a long history before presentation and diagnosis. Clinical and radiological findings are unhelpful in making an early diagnosis. The five year survival rate in this series was 43%. The best guide to prognosis was assessment of mitotic activity. A high index of suspicion is required if the diagnosis is not to be missed. Adequate wide excision of the tumour is the mainstay of treatment.

Synovial sarcoma. Evaluation of Prognosis with Emphasis on the Study of DNA Ploidy and Proliferation (PCNA and Ki‐67) Markers

“…The 5-year survival rates range from 30.0 to 82.6%. The 64% 5-year survival rate observed in the present series of localized SS is within the range of the series previously reported (Table 5) [6,8,12,20,22,23,25,29,[32][33][34]37,41,44,46,47,50,52,56].…”

“…Synovial sarcoma (SS) is a rare soft tissue tumor, usually of high grade malignancy. Since 1980 all but one series on record dealing with survival rates are based upon less than 100 cases [6,8,12,20,22,23,25,29,[32][33][34]37,41,44,46,47,50,52,56].…”

“…Many clinical and morphological features have been applied to the evaluation of the prognosis of synovial sarcoma (SS), such as gender, age at diagnosis, clinical symptoms, location of tumor, staging of the neoplastic disease, treatment modalities, tumor size, histologic subtype, extent of glandular differentiation, mitotic rate, histologic grading, presence of rhabdoid cells, amount of mast cells, extent of calcification, DNA ploidy score, and PCNA score. However, there is still contradictory and insufficient evidence concerning the validity of most of these parameters [2,6,8,10,17,19,20,22,23,25,29,33,34,[36][37][38][39]41,43,44,47,50,52,56].…”

“…The prognostic significance of histologic subtyping of SS remains controversial. Several authors conclude that there are no significant differences between the survival of patients with the two most common subtypes of SS (BSS and MSS) [6,10,17,22,23,25,33,38,39,43]. On the other hand, some groups have found BSS to carry a more favorable prognosis [8,56] and others have found that MSS appears to be the less aggressive variant [36,47].…”

Variability in the presentation of synovial sarcoma in children

“…7 The early diagnosis of any soft-tissue sarcoma should lead to a better outcome, since it will be smaller and it should prove easier to obtain clear excisional margins. 8,9 Synovial sarcomas, however, are unusual because they often do not present in a manner typical of soft-tissue sarcoma and delays in diagnosis are frequent. 10,11 Furthermore, it is not uncommon for patients to have excision of a lump, without the suspicion that it could be a sarcoma, which results almost inevitably in contaminated margins and the need for further surgery.…”