Intra-articular Synovial Sarcoma of the Knee with Extension to the Distal Thigh: A case report 

Main Article Content

Teodora Delibašic
Dušan Rnjak
Dragana Grbić

Abstract

Objective: We present a case of intra-articular synovial sarcoma of the knee with expansion to the distal thigh with developed metastatic lung disease. The case was complicated by the detection of primary pulmonary adenocarcinoma.


Case: A 70 year age woman reported pain in the right knee during a routine check–up. Ultrasound (US) finding was inconclusive since the detected intra–articular tumor, appeared to be a partially organised haematoma. Magnetic resonance imaging (MRI) indicated the tumor corresponds to SS, and radical tumor resection was performed. Due to developed distant lung metastases, the patient received two different chemotherapy protocols. Good response to the second chemotherapy enabled video–assisted thoracoscopic surgery and removal of the remaining deposits in the left lung. Unexpected detection of primary adenocarcinoma of the lung and its metastases required a new chemotherapy protocol, which the patient is currently undergoing.


Conclusion: SS's insidious onset and infrequency often delay the diagnosis. Common occurrences of lung metastases require the selection of adequate chemotherapy, and continuous follow – up. Laboratory and radiographic monitoring remain mandatory to ensure the absence of both primary diseases and to detect recurrent metastatic activity.

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How to Cite
Delibašic, T., Rnjak, D., & Grbić, D. (2023). Intra-articular Synovial Sarcoma of the Knee with Extension to the Distal Thigh: A case report . Medical Science and Discovery, 10(3), 208–211. Retrieved from https://medscidiscovery.com/index.php/msd/article/view/913
Section
Case Reports
Received 2023-03-09
Accepted 2023-03-17
Published 2023-03-21

References

Bergovec M, Smerdelj M, Bacan F, Seiwerth S, Herceg D, Prutki M. Intraarticual synovial sarcma of the knee rising from the lateral meniscus – a case report. Orthopaedics & Traumatology: Surgery & Research. 2018; 227 – 230.

Khan Y, Carey-Smith R, Taylor M, et al. Treatment and outcomes for synovial sarcoma patients in Western Australia: the role of neoadjuvant chemoradiotherapy. Cancer Reports. 2020; 3:e1268. https:// doi.org/10.1002/cnr2.1268

Desar IM, Fleuren ED, van der Graaf WT. Systemic treatment for adults with synovial sarcoma. Curr. Treat. Options in Oncol. 2018; 19: 13.

Eilber FC, Brennan MF, Eilber FR, Echardt JJ, Grobmyer SR, et al. Chemotherapy is associated with improved survival in adult patinets with primary extremity synovial sarcoma. Ann Surg 2007; 246: 105–113.

Kraunsdorf MJ. Malignant soft – tissue tumors in a large referral population: distribution ofdiagnoses by age, sex and location. AJR 1995; 164: 129 – 134.

Ishida T, Iijima T, Moriyama S, Nakamura C, Kitagawa T, Machinami R. Intra – articular synovial sarcoma mimicking chondromatosis. Skeletal Radiol. 1996; 25: 766 – 769.

Fletcher KU, Mertens F, eds. WHO Classification of tumors. Pathology and Genetics. Tumors of soft tissue and bone. Lyon- IARC Press; 2002.

Brennan MF, Singer S, Maki RG, et al. Sarcomas of the soft tissues and bone. Cancer: principles and practice of oncology, vol.35 Philadelphia. PA: Lippincot Williams &Willkins. 2005; 1584.

Kransdorf MJ, Murphey MD. Radiologic evaluation of soft – tissue masses: a current perspective. AJR. 2011; 175: 575 – 587.

Vlenterie M, Litiere S, Rizzo E, Marreaud S, Judson J, et al. Outcome of chemotherapy in advanced synovial sarcoma patients: review of 15 clinical trials from the European Organisation for research and treatment of cancer – Soft tissue and bone sarcoma group. Setting a new landmark for studies in this entity. Eur J Cancer. 2016; 58: 62 – 72.

Judson I, Verweij J, Gelderblom H, Hartman JT, Schoffski P, Blay JY et al. Doxorubicin alone vs. intensified doxorubicin plus ifosfamide for first – line treatment of advanced or metastatis soft tissue sarcoma: a randomized controlled phase 3trial. Lancet Oncol 2014; 15(4): 415 – 23.

Pan M, Merchant M. Risk factors including age, stage and anatomic location that impact the outcomes of patients with synovial sarcoma. Medical Sciences. 2018; 6(1):21. https://doi.org/10.3390/medsci6010021

Mihajlovic J, Pechiuangolou P, Miladinov – Mikov M, Zivkovic S, Postma MJ. Cancer incidence and mortality in Serbia 1999 – 2009. BMC Cancer 2013; 13:18.

Myers DJ, Wallen JM. Lung Adenocarcinoma. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing. 2021; Available from: https://www.ncbi.nlm.nih.gov/books/NBK519578/

Cao L, Lv L. Breast metastasis from EGFR/ALK negative lung adenocarcinoma: A case report. Medicine. Baltimore. 2020; 99: 49.

Inamura K, Yakouchi Y, Sakakibara R, Kobayashi M et al. Relationship of tumor PD – L1 expression with EGFR wild – type status and poor prognosis in lung adenocarcinoma. Jpn J Clin Oncol. 2016; 46(10): 935 – 941.

Miller RP, Tadagavadi RK, Ramesh G, William BR. Mechanisms of cisplatin nephrotoxicity. Toxins 2010; 2: 2490 – 2518.

Sederholm C, Hillerdal G, Lamberg K, Kölbeck K, Dufmats M, Westberg R, Gawande SR. Phase III trial of gemcitabine plus carboplatin versus single-agent gemcitabine in the treatment of locally advanced or metastatic non-small-cell lung cancer: the Swedish Lung Cancer Study Group. J Clin Oncol. 2005; 23(33): 8380-8.