Synovial sarcoma is a type of soft tissue sarcoma. Soft tissue sarcomas are cancers of the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body, including synovial tissue. Synovial tissue lines the cavities of joints, such as the knee or elbow, tendons (tissues that connect muscle to bone), and bursae (fluid-filled, cushioning sacs in the spaces between tendons, ligaments, and bones). Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential (the ability to give rise to various cell type) mesenchymal cells (cells that develop into connective tissue, blood vessels, and lymphatic tissue) near joint surfaces, tendons, tendon sheaths, juxta-articular (near a joint) membranes, and fascial aponeurosis (binds muscles together). Although synovial sarcoma does not have a clearly defined cause, genetic factors are believed to influence the development of this disease.
Synovial sarcoma is rare. It accounts for between 5 and 10 percent of the approximately 10,000 new soft tissue sarcomas reported each year. Synovial sarcoma occurs mostly in young adults, with a median age of 26.5. Approximately 30 percent of patients with synovial sarcoma are younger than 20. A study with 672 cases at the Armed Forces Institute of Pathology (AFIP) demonstrated no significant sex or ethnic predisposition for synovial sarcoma.
Synovial sarcoma is the most common sarcoma that involves the upper extremity, hip, groin, and buttocks in patients aged 16-25 years. In patients aged 6-45 years, synovial sarcoma is the most common sarcoma in the foot and ankle. About 50 percent of synovial sarcomas develop in the legs, especially the knees. The second most common location is the arms. Less frequently, the disease develops in the trunk, head and neck region, or the abdomen. It is common for synovial cancer to recur (come back), usually within the first two years after treatment. Half of the cases of synovial sarcoma metastasize (spread to other areas of the body) to the lungs, lymph nodes, or bone marrow.
Synovial sarcoma is a slow-growing tumor. Because it grows slowly, a person may not have or notice symptoms for some time, resulting in a delay in diagnosis. The most common symptoms of synovial sarcoma are swelling or a mass that may be tender or painful. The tumor may limit range of motion or press against nerves and cause numbness. The symptoms of synovial sarcoma can be mistaken for those of inflammation of the joints, the bursae, or synovial tissue. These noncancerous conditions are called arthritis, bursitis, and synovitis, respectively. Or in my mom's case I believe the doctors throught it was a plantar fibroma.
The doctor may use the following procedures and tests to diagnose synovial sarcoma:
*****MRI has proven to be valuable for the detection and staging of soft-tissue tumors, but MRI signal intensity characteristics are usually nonspecific for a histologic diagnosis, with some exceptions (for example: lipomas, some liposarcomas, pigmented villonodular synovitis). Although certain signs can suggest synovial sarcoma in the differential diagnosis, MRI findings are by no means diagnostic for a particular disease. Histologic (the study of cells and tissues at the microscopic level) analysis of the involved tissue is usually required for definitive diagnosis.*****
The type of treatment depends on the age of the patient, the location of the tumor, its size, its grade (how abnormal the cancer cells look under a microscope and how likely the tumor will quickly grow and spread), and the extent of the disease. The most common treatment is surgery to remove the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). Amputation may be necessary. If the first surgery does not obtain negative tissue margins, a second surgery may be needed.
The patient may also receive radiation therapy before or after surgery to control the tumor or decrease the chance of recurrence (cancer coming back). The use of intraoperative radiation therapy (radiation aimed directly at the tumor during surgery) and brachytherapy (radioactive material sealed in needles, wires, seeds, or catheters, and placed directly into or near a tumor) are under study.
Patients may also receive chemotherapy alone or in combination with radiation therapy.
Nobody likes to talk about this but here are the facts:
Decreases to the NIH have slowed down new studies but there are some studies available. Participation in clinical trials is an important treatment option for many people with synovial sarcoma. Studies are in progress to determine the effectiveness of biological therapies (treatment to stimulate or restore the ability of the immune system to fight cancer), including monoclonal antibodies, and chemotherapy with hyperthermia (kills tumor cells by heating them to several degrees above body temperature).
People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI’s Cancer Information Service (CIS) (see below) at 1–800–4–CANCER and in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know, which can be found at http://www.cancer.gov/publications on the Internet. This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials on the NCI’s Web site. The Web site offers detailed information about specific ongoing studies by linking to PDQ®, the NCI’s cancer information database. The CIS also provides information from PDQ.
My mom was diagnosed with Synovial Sarcoma at the age of 50. Several doctors misdiagnosed her. And how, do you ask? The doctors failed to do any type of radiological tests or biopsy. All they did was look, feel, and gave her orthotics. By the time the doctors realized they were dealing with more than a harmless lump the tumor in my mom's foot spread all the way to her mid-calf. I believe at that point the tumor was already stage 3. If any doctors are reading this, let my mother's case be a hard lesson for you: looking and feeling a lump is not a proper diagnosis. It is poor and cheap HMO tactics to save money. It is ABSOLUTE LAZINESS and defies the Hippocratic Oath. The modern translation, "to practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them" can be interpreted in many ways but to me, it's pretty clear that doctors should not half-a** an accessment/diagnosis.
To the people in general: if you ever feel like more should be done to make a clear diagnosis, be an advocate for your health. Complain, whine, and do whatever it takes so the appropriate tests are done. From there you know exactly what the next course of action is. A lump should be examined with radiological images. A lump should be examined with a biopsy. NEVER ASSUME ANYTHING AND DON'T TRUST DOCTORS THAT GIVE YOU REVOLVING DOOR EXAMS.
Misdiagnosis put my mom to an early grave.