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1、Imaging of Synovial Sarcoma with Radiologic-Pathologic Correlation Synovialsarcomaisthefourthmostcommonmalignantprimarysoft-tissueneoplasm.Theradiologicmanifestationsandspectrumofsynovialsarcomareflecttheunderlyingpathologicappearance.Wehavereviewed,illustrated,andcorrelatedtheclinical,pathologic,an
2、dradiologicfeaturesofsynovialsarcomaaswellasthetreatmentandprognosis.Althoughtheradiographiccharacteristicsofsynovialsarcomaarenotpathognomonic,thefindingsofasoft-tissuemass,particularlyifcalcified,nearbutnotinajointinayoungpatient(1540yearsofage)areverysuggestiveofthisdiagnosis.Cross-sectionalimagi
3、ngfeaturesarevitalforstagingextentandforplanningsurgicalresection.Theyalsofrequentlyrevealsuggestiveappearancesofmultilobulationandmarkedheterogeneity(creatingthetriplesign)withhemorrhage,fluidlevels,andsepta(creatingthebowlofgrapessign).Twofeaturesassociatedwithsynovialsarcomathatmayleadtoaninitial
4、mistakendiagnosisofabenignindolentprocessareslowgrowth(averagetimetodiagnosis,24years)andsmallsize(5cmatinitialpresentation);inaddition,theselesionsmaydemonstratewell-definedmarginsandhomogeneousappearanceoncross-sectionalimages.Synovialsarcomaisanintermediate-tohigh-gradelesion,and,despiteinitialag
5、gressivewidesurgicalresection,localrecurrenceandmetastaticdiseasearecommonandprognosisisguarded.Understandingandrecognizingthespectrumofradiologicappearancesandtheirpathologicbasesallowimprovedpatientassessmentandareimportantforoptimalclinicalmanagement.Synovialsarcomawithanintermuscularoriginadjace
6、nttothehipofan18-year-oldmanwhonoticedanenlargingsoft-tissuemass.(a, b)AxialT1-weighted(a,)andT2-weighted(b)magneticresonance(MR)imagesshowalargejuxtaarticularheterogeneoussoft-tissuemass(M)withsignalintensityslightlyhigherthanthatofmusclewithT1weightingandintermediatesignalintensitywithT2weighting.
7、Thelesioniscenteredbetweentherectus(arrow),tensorfascialata(T),andsartorius(S)muscles,whicharedisplaced.Asmallamountofintermuscularfatisseenposteriorly(arrowhead).(c)Photographoftheaxiallysectionedgrossspecimenrevealssimilarfeatureswithaseptated,multilobulatedsoft-tissuemass(*)arisingbetweentherectu
8、s(arrow),tenorfascialata(T),andsartorius(S)muscles.Synovialsarcomaoftheposteriorchestwallina31-year-oldmanwithanontender,progressivelyenlarging,soft-tissuemass.(a)Axialpostcontrastcomputedtomographic(CT)scanshowsalargeposteriorchestwallmasswithlowattenuationcentrally(*)resultingfromnecrosisandathick
9、nodularwallperipherally(arrows).(b)Photographoftheaxiallysectionedgrossspecimenrevealssimilarfeatures,withnecrosis(N)centrallyandathicknodularwallofviabletumor(T)peripherally.Synovialsarcomaadjacenttotheankleina37-year-oldwomanwithasoft-tissuemassnotedaftertraumaanddevelopmentofhematoma.(a)Angiogram
10、showsdensetumorstainingandneovascularity(arrowheads)ofthelargesoft-tissuemassadjacenttotheankle.Theposteriortibialarteryisdisplaced(arrows).(b)AxialT2-weighted(2000/80)MRimagerevealsmarkedheterogeneityandmultilobulation(bowlofgrapessign)withthetriplesign(areasofhighH,intermediateI,andlowLsignalintensity),fluidlevels(arrowheads)resultingfromhemorrhage,andcorticalerosion(arrows).(c)Photographofthesectionedgrossspecimenshowsthemultilobulatedhemorrhagicmorphology(*)correspondingtotheMRimagingappearance.
