1、Imaging of Synovial Sarcoma with Radiologic-Pathologic Correlation,Synovial sarcoma is the fourth most common malignant primary soft-tissue neoplasm. The radiologic manifestations and spectrum of synovial sarcoma reflect the underlying pathologic appearance. We have reviewed, illustrated, and correl
2、ated the clinical, pathologic, and radiologic features of synovial sarcoma as well as the treatment and prognosis.,Although the radiographic characteristics of synovial sarcoma are not pathognomonic, the findings of a soft-tissue mass, particularly if calcified, near but not in a joint in a young pa
3、tient (1540 years of age) are very suggestive of this diagnosis. Cross-sectional imaging features are vital for staging extent and for planning surgical resection.,They also frequently reveal suggestive appearances of multilobulation and marked heterogeneity (creating the triple sign) with hemorrhag
4、e, fluid levels, and septa (creating the bowl of grapes sign). Two features associated with synovial sarcoma that may lead to an initial mistaken diagnosis of a benign indolent process are slow growth (average time to diagnosis, 24 years) and small size (5 cm at initial presentation); in addition, t
5、hese lesions may demonstrate well-defined margins and homogeneous appearance on cross-sectional images.,Synovial sarcoma is an intermediate- to high-grade lesion, and, despite initial aggressive wide surgical resection, local recurrence and metastatic disease are common and prognosis is guarded. Und
6、erstanding and recognizing the spectrum of radiologic appearances and their pathologic bases allow improved patient assessment and are important for optimal clinical management.,Synovial sarcoma with an intermuscular origin adjacent to the hip of an 18-year-old man who noticed an enlarging soft-tiss
7、ue mass.(a, b)Axial T1-weighted (a, ) and T2-weighted (b) magnetic resonance (MR) images show a large juxtaarticular heterogeneous soft-tissue mass(M)with signal intensity slightly higher than that of muscle with T1 weighting and intermediate signal intensity with T2 weighting. The lesion is centere
8、d between the rectus (arrow), tensor fascia lata(T), and sartorius(S)muscles, which are displaced. A small amount of intermuscular fat is seen posteriorly (arrowhead).(c)Photograph of the axially sectioned gross specimen reveals similar features with a septated, multilobulated soft-tissue mass (*) a
9、rising between the rectus (arrow), tenor fascia lata(T), and sartorius(S)muscles.,Synovial sarcoma of the posterior chest wall in a 31-year-old man with a nontender, progressively enlarging, soft-tissue mass.(a)Axial postcontrast computed tomographic (CT) scan shows a large posterior chest wall mass
10、 with low attenuation centrally (*) resulting from necrosis and a thick nodular wall peripherally (arrows).(b)Photograph of the axially sectioned gross specimen reveals similar features, with necrosis(N)centrally and a thick nodular wall of viable tumor(T)peripherally.,Synovial sarcoma adjacent to t
11、he ankle in a 37-year-old woman with a soft-tissue mass noted after trauma and development of hematoma.(a)Angiogram shows dense tumor staining and neovascularity (arrowheads) of the large soft-tissue mass adjacent to the ankle. The posterior tibial artery is displaced (arrows).(b)Axial T2-weighted (
12、2000/80) MR image reveals marked heterogeneity and multilobulation (bowl of grapes sign) with the triple sign (areas of high H, intermediate I, and low L signal intensity), fluid levels (arrowheads) resulting from hemorrhage, and cortical erosion (arrows).(c)Photograph of the sectioned gross specimen shows the multilobulated hemorrhagic morphology (*) corresponding to the MR imaging appearance.,
