Inguinal synovial sarcoma revealed by a limb swelling: A case report

Abstract

Introduction and importance: Synovial sarcoma is a malignant soft tissue tumor typically found near joints; its occurrence in the inguinal region is very rare.

Case presentation: We report a 23-years-old who presented with lower limb swelling. Imaging studies revealed a tumor in the groin area, compressing the femoral vein. A trucut biopsy concluded a synovial sarcoma. A complete resection was performed and the patient had adjuvant radiotherapy and chemotherapy with no evidence of reccurrence at 2-years follow-up.

Clinical discussion: Synovial sarcoma accounts for approximately 8 to 10 % of all soft tissue sarcomas. It is predominantly localized near the large joints in the limbs, with the inguinal location being extremely rare. Clinical diagnosis of the mass can sometimes be challenging. A needle biopsy, followed by histological analysis, is necessary to establish the diagnosis. MRI is considered the gold standard radiological examination for local staging of the tumor. The main treatment approach for synovial sarcoma is wide-margin resection, involving en-bloc resection of the tumor with clear margins. Vascular resection and reconstruction should be considered for involved vessels. Some authors argue that resection alone is sufficient for treating primary synovial sarcoma. However, adjuvant chemotherapy may be effective in cases where surgery quality is poor, making it a non-standard treatment. Others have highlighted the potential benefits of adjuvant radiotherapy, particularly in high-grade tumors.

Conclusion: Surgical excision remains the mainstay of treatment. Therefore, it is necessary to be aware of the different clinical presentations, which can sometimes be unusual.

Keywords: Adjuvant treatments; Case report; Inguinal region; Surgical resection; Synovial sarcoma.

Fig. 1

MRI section showing a mass with high signal on T1 WIexerting a mass effect on femoral pedicle.

Fig. 2

Per-operative view showing the tumor in contact with the femoral pedicle before dissection.

Fig. 3

The surgical specimen measuring 8 × 6 × 4cm which presents macrospically necrotic, hemorrhagic and cystic remodelings.

Fig. 4

Microscopic section of the tumor showing sarcomatous proliferation made up of two components: a spindle cell component and an epithelial component.