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Synovial Sarcoma - Radiology

last modified on: Thu, 05/02/2024 - 12:06

updated by Piper Wenzel, BS May 2024

  • Synovial sarcoma: high-grade malignancy accounting for 2.5-3.5% of head and neck sarcomas and 0.1% of all head and neck cancers (Stanbouly 2021)
  • Arises from pluripotent mesenchymal cells rather than mature synovial cels (Stanbouly 2021)
  • Most common location in the head and neck region is the hypopharynx/parapharyngeal space (Quan 2023, Lin 2021)
  • Sinonasal synovial sarcoma is rare and occurs more commonly in young adults with a slight male predominance (Lin 2021)
  • Often presents with hoarseness and subsequent stridor and dyspnea, but patients may be aymptomatic (Stanbouly 2021)
  • Non-specific gross appearance; some features may include hemorrhage, necrosis, cystic changes (Lin 2021)
  • Multiple histologic subtypes: monophasic spindle cell, biphasic, poorly differentiated, myxoid, ossifying and monophasic epithelial (Stanbouly 2021)
  • Immunohistochemstry may be positive for BCL-2 and CD99 (Lin 2021)
  • CT imaging of sinonasal synovial sarcoma: (Lin 2021)
    • Non-contrast - isoattenuation
    • Contrast-enhanced - "marked enhancement with areas of hypointensity, indicating necrosis and cysts" (Lin 2021)
    • Calcifications may be seen on the peripheral regions of the tumor
    • Bony changes (bone absorption, erosion, reactive sclerosis) may be noted
  • MRI imaging of sinonasal synovial sarcoma: (Lin 2021) 
    • "Triple sign" - varied amounts of hypo-, iso-, and hyperintense signals
    • T2-weighted - "Cobblestone-like" appearance: "multiple cystic areas of high signal with clearly defined septa"

Non-contrast CT

MPNST_CTwithout_0727

MPNST_T1_0727

MPNST_T2_0727

MPNST_T1post_0727

References

Lin N, Liu X, Zhang F, Pan Y, Qi M, Sha Y. Sinonasal synovial sarcoma: evaluation of the role of radiological and clinicopathological features in diagnosis. Clin Radiol. 2021;76(1):78.e1-78.e8. doi:10.1016/j.crad.2020.08.007

Quan H, Sreekissoon S, Wang Y. Synovial sarcoma of the head and neck: A review of reported cases on the clinical characteristics and treatment methods. Front Cell Dev Biol. 2023;10:1077756. Published 2023 Jan 6. doi:10.3389/fcell.2022.1077756

Stanbouly D, Litman E, Lee KC, Philipone E. Synovial sarcoma of the head & neck: A review of reported cases in the literature. J Stomatol Oral Maxillofac Surg. 2021;122(5):505-510. doi:10.1016/j.jormas.2020.12.001