Synovial sarcoma of the hand - case report and literature review

Abstract

Introduction. Synovial sarcoma is a rare malignant tumor most often localized on the lower limbs near large joints. Histopathology findings is the gold standard for making the diagnosis. However, due to the similarity with other tumors, the findings can be misinterpreted and the correct diagnosis often delayed, and the treatment is inadequate in the early stages of the disease inadequate. Case Report. A 15-year-old female patient came for an examination due to subcutaneous lesion in her hand. The lesion was excised on three occasions due to recurrence, and each time the histopathology findings showed a dermatofibroma. After five years, the patient returned due to the changes under the scar and unpleasant sensations. A surgical excision was performed when dermatofibroma was verified. Two years later, the patient developed necrosis of the entire finger. The finger was amputated, and synovial sarcoma was verified. The patient underwent 25 cycles of radiotherapy. In the following year and a half, the tumor developed metastases, first locoregional and then distant, in the region of the left shoulder joint and the left lung. Conclusion. The histopathological similarity of this tumor with other benign changes indicates the need for further evaluation and differentiation of the pathohistological characteristics from tumors with similar characteristics. Early detection of this type of tumor enables a more favorable course and outcome of the treatment of these patients. Initial radical surgical treatment of this type of tumor is necessary due to the aggressiveness they show and the high frequency of local recurrence.