Synovial Sarcoma of the Extremities: Prognostic Factors for 20 Nonmetastatic Cases and a New Histologic Grading System With Prognostic Significance

Abstract

PURPOSE:To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS:The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

Thoracic spinal cord compression secondary to metastatic synovial sarcoma: case report

“…Synovial sarcomas are uncommon malignant soft tissue neoplasms, representing less than 1% of all cancers 11,12 and accounting for an estimated 5 to 10% of all soft tissue sarcomas [11][12][13][14][15] . It is the fourth most common soft-tissue sarcoma in adults 16 after malignant fibrous histiocytoma, liposarcoma, and rhabdomyosarcoma 15 . Synovial sarcoma occurs primarily in adolescents and young adults between 15 and 40 years of age, affecting males more frequently than females 11,12,15,17,18 .…”

“…It is the fourth most common soft-tissue sarcoma in adults 16 after malignant fibrous histiocytoma, liposarcoma, and rhabdomyosarcoma 15 . Synovial sarcoma occurs primarily in adolescents and young adults between 15 and 40 years of age, affecting males more frequently than females 11,12,15,17,18 . It usually arises in the periarticular regions near large joints, with 75 to 90% of cases involving the extremities 11,15 , especially the lower extremity 15 .…”

“…Synovial sarcoma occurs primarily in adolescents and young adults between 15 and 40 years of age, affecting males more frequently than females 11,12,15,17,18 . It usually arises in the periarticular regions near large joints, with 75 to 90% of cases involving the extremities 11,15 , especially the lower extremity 15 . A wide variety of other anatomic primary sites have been reported, including heart, lungs, small intestine and peripheral nerves 13,[19][20][21] .…”

“…Synovial sarcoma is characterized by epithelial-like and spindle cell components arranged in a biphasic or monophasic pattern; there is also a poorly differentiated (PD) form 14 . Synovial sarcomas are microscopically divided into four histological subtypes: biphasic (the most predominant type); monophasic fibrous; monophasic epithelial; and poorly differentiated; the biphasic type contains a glandular component in addition to the monophasic spindle cells 12,13,15,27 . Synovial sarcoma remains one of the most aggressive soft-tissue sarcomas, despite improvements in staging, surgical technique, and adjuvant therapies 15 .…”

“…Synovial sarcomas are microscopically divided into four histological subtypes: biphasic (the most predominant type); monophasic fibrous; monophasic epithelial; and poorly differentiated; the biphasic type contains a glandular component in addition to the monophasic spindle cells 12,13,15,27 . Synovial sarcoma remains one of the most aggressive soft-tissue sarcomas, despite improvements in staging, surgical technique, and adjuvant therapies 15 . According to Baptista et al 15 , most pathologists consider synovial sarcoma as a high-grade soft-tissue sarcoma, though they consider the biologic behavior, in some cases, to be more benign than others 15 .…”