Poorly Differentiated Synovial Sarcoma of the Lumbar Spine in a Fourteen-year-old Girl: A Case Report

Synovial sarcoma is a highly malignant soft-tissue tumor of mesenchymal origin that accounts for approximately 5.8% to 10% of all soft-tissue sarcomas1,2. Nearly 90% of these tumors are discovered in an extremity, with the majority involving the lower limbs1-3. Synovial sarcoma within the lumbar spine has been mentioned in only a handful of reports in the English-language literature4-9, typically as part of a case series or as the subject of study for various imaging modalities. Occurrence in the pediatric population at this location is even rarer. The purpose of the present report is to describe the case of a fourteen-year-old girl with lumbar synovial sarcoma and to document the treatment algorithm that was used. The patient was informed that data concerning the case would be submitted for publication, and she consented. A fourteen-year-old girl with no related medical history presented to her pediatrician in November 2001 with unresolved lower back pain two weeks after being struck in the lumbar region while playing soccer. Following this incident, she began experiencing paresthesias in the left lower extremity (and occasionally the right lower extremity) and on questioning was able to recall a history of mild and occasional low-back pain during the previous two months. Physical examination revealed a firm, fixed palpable mass in the lumbar paraspinal muscles, and the patient was referred for imaging studies. No neurologic examination was noted at that time. A magnetic resonance imaging scan of limited quality secondary to patient movement showed a large lesion that was located mostly in the lumbar paraspinal muscles with extension into the spinal canal at the L3-L4 level with resultant compression of the thecal sac. The patient was referred for orthopaedic consultation and was transferred to Fletcher Allen Health Care in …