H. Frimmel (Halle/S.)  

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11 Months  

Female  

Arm-Muscular system / Connective tissue / Skin  

neoplastic  

Age at diagnosis:11 month-old female infant. According to the parents, trauma of the right shoulder. Presumed luxation or rupture.  

Malignant tumor of the synovial lining, i.e. histologically, the tumor imitates synovial tissue.
Origin is from the joint's capsule, synovial sheath and bursae. The synovial sarcoma originates more frequently from the synovial sheath as from the capsule.
The tumor's borders are usually sharp, without proof of peritumoral edema.
Calcifications are found in 30% of the cases, often septation and fluid levels due to hemorrhaging. Thereby somewhat inhomogenic tumor structure.  

<- view MRI 1

MRI 1: T2-transversal: Signal intense mass of about 6 x 6 x 5cm in the right axilla with expansion up into the subscapular soft tissue. Laterally, the transversally sliced humerus can be seen.






<- view MRI 2

MRI 2: T1-SE cor: Mass in the right axilla with expansion up into the subscapular soft tissue. Practically isointense with muscle, solitary signal absence in both weighted images.






<- view MRI 3

MRI 3: Proton weighted image with fat saturation; coronal. The tumor lies on the proximal humerus, the scapula and the thoracic wall. One infiltration of the bony structures is not seen.






<- view MRI 4

MRI 4: T1-SE-semi-sag after contrast: diffuse uptake of contrast.






<- view MRI 5

MRI 5: T1-SE-semi-sag without contrast.



 

Surgery / Histo  

A diagnosis with imaging alone is not always possible. Principally, many other soft tissue tumors are possible. In some instances, a pigmented, villonodular synovialitis (PVNS) could be discussed.  

In this case, an adjuvant radiochemotherapy was performed after tumor resection (histological findings: R1-resection). About 1.5 years after the begin of symptoms, there have been no posttherapeutic changes confirmed by imaging.  

A patient with the same diagnosis was introduced to Ms. Hahn (Dresden). In our example, the tumor was somewhat more homogenically structured. The course under treatment seems similar so far .  

N/A  

1. Medline:
Bohndorf,K.; Imhof,H.
Radiologische Diagnostik der Knochen und Gelenke
Thieme-Verlag Stutgart 1998

2. Medline:
Vahlensieck,M.; Reiser,M.
MRTdes Bewegungsapparates
Thieme-Verlag Stuttgart 1997  

synovial sarcoma, synovialoma, soft-tissue tumor, shoulder joint, thorax wall, synovia, sarcoma, malignant tumor of synovia, child, childhood, pediatric radiology  

H Frimmel. Synovial sarcoma (Synovialoma). PedRad [serial online] vol 2, no. 11.
URL: www.PedRad.info/?search=20021120131009