Synovial sarcoma of the spine: a case involving paraspinal muscle with extensive calcification and the surgical consideration in treatment

Abstract

Introduction Synovial sarcoma is a rare malignant tumor of the spine. This tumor may present as a painless mass of the spine or slowly enlarge, causing pain or neurologic deficits. As it is difficult to differentiate this lesion from other soft tissue tumors, synovial sarcoma requires histologic confirmation for definite diagnosis. Thus, the treatment strategy is often planned in the final step depending on the pathologic results. Despite its rare incidence, a few cases of primary or metastatic synovial sarcoma involving the spinal cord, foramen, vertebral body, or paraspinal muscles have been reported in the literature. Materials and methodsWe present the case of a 29-year-old man with a synovial sarcoma in the paraspinal muscle of the cervical spine. The patient was evaluated radiologically and histologically. Plain radiography, computed tomography, and magnetic resonance imaging were performed as part of the preoperative workup, and immunohistochemical and cytogenetic studies were additionally performed to identify the histologic features of the tumor. The patient underwent marginal resection followed by adjuvant radiation therapy. The patient has been followed up for 2 years. Conclusions This article highlights the features of synovial sarcoma of the spine via a comprehensive review. Synovial sarcoma of the spine is uncommon, but it is a challenging issue in both diagnostic and therapeutic aspects. The currently available evidence suggests the use of a multidisciplinary approach in the treatment of synovial sarcoma, which includes complete resection and radiation therapy.

An infant with intradural extramedullary synovial sarcoma: the youngest case in the literature

“…2,19 Spinal SS is a rare entity also in the adult population and up to now, only 18 adult patients have been documented as case reports in the literature. 5,6 Wide surgical excision with negative surgical margins followed by chemotherapy and/or radiotherapy is the currently recommended treatment in the adult population. To preserve the adjacent structures and limit the neurologic impairment, marginal resection was performed in most of these reported patients.…”

“…Almost all of the reported cases are adults and majority of their tumors were located outside the duramater. 5,6 Here, we present a case of primary intradural extramedullary SS in the cervicothoracic region. To our knowledge, this is the youngest case of intradural extramedullary spinal SS in the literature.…”

Surgical management and outcome of synovial sarcoma in the spine

“…En bloc resection is important in spinal tumours to minimize the tumour residue. Kim et al [ 6 ] reported a C2 SS removed with negative margins, and Cao et al [ 33 ] reported another case who underwent a T7 en bloc resection. Both patients survived without recurrence in their 2- and 1-year follow-up, respectively.…”

“…It can arise from the osseous and paravertebral soft tissues and even metastasize from other sites [ 4 , 5 ]. With the enlargement of a SS, the mass can result in pain and other symptoms [ 6 , 7 ]. Spinal instability, vertebral collapse and neurologic deficits may occur from the destruction of vertebrae structure and compression of nerve roots and the spinal cord [ 8 , 9 ].…”

Expert’s comment concerning Grand Rounds case entitled “Synovial sarcoma of the spine: a case involving paraspinal muscle with extensive calcification and the surgical consideration in treatment” (by Junhyung Kim, Sun-Ho Lee, Yoon-La Choi, Go Eun Bae, Eun-Sang Kim, Whan Eoh)

“…The authors describe a case of a 29-year-old male with a non-metastatic paraspinal muscle calcified synovial sarcoma [10]. Surgical resection achieved adequate margins (complete excision) and the patient received adjuvant external beam radiotherapy (60 Gy).…”