Das Synovialsarkom in der klinischen Praxis - eine Zusammenstellung ausgesuchter Fälle

Clinically, synovial sarcoma becomes apparent as a growing mass. Initial presentation and the course may be variable. We discuss 4 characteristic patients. Case 1: A 37 year-old female patient presented with a mass in herthigh after two consecutive resections of a malignant hemangio-endothelioma. Histology: Biphasic synovial sarcoma (G II). Case 2: A tumor was enucleated in the adductors of a 42 year-old female patient. Histology: Biphasic synovial sarcoma (G I). 2 years later local tumor recurrence (G I) occurred. Treatment was provided by wide resection and radiotherapy. Case3: Resection of a suspected neurinoma in the thigh of a 34 year-old male patient. Histology: Biphasic synovial sarcoma, positive margins. Case4: A 74 year-old female patient receiving anticoagulants was symptomatic due to intracranial tumor hemorrhage of metastasis of a previously unknown synovial sarcoma of her popliteal fossa. The primary tumor was initially misdiagnosed as Baker's cyst, causing a deep vein thrombosis. Histology: Angioinvasive synovial sarcoma (G II). Survival: 11 months. Therapy: Wide resection and postoperative irradiation in cases 1-3.Indication for the irradiation in case 2 and 3 was due to the inadaequate operation. An amputation was performed in case 4 4 because of infiltration of the neurovascular structures. Conclusion: The presentation of synovial sarcoma does not differ from other soft tissue sarcomas. Patients should be treated in specialized centers to reduce inadaequate operations. Outcome and rate of metastatic disease suggest the need for improved adjuvant treatment modalities.