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. 2003 Sep-Dec;7(3-4):131–135. doi: 10.1080/13577140310001644788

Premonitory Pain Preceding Swelling: A Distinctive Clinical Presentation of Synovial Sarcoma which may Prompt Early Detection

M V Chandu De Silva 1,2, Ann Barrett 3, Robin Reid 1,✉
PMCID: PMC2395526  PMID: 18521377

Abstract

Purpose: The aim of this paper is to document the unusual presentation of long-standing pain at the tumour site before development of a swelling in patients with synovial sarcoma.

Patients/methods and results: The clinical presentation of 53 patients with synovial sarcoma was compared with 56 randomly selected patients with other sarcomas of the trunk and extremities. The two groups were similar with regard to age (P = 0.980), sex (P = 0.784) duration of symptoms (P = 0.697), size (P = 0.931) and site of tumour (P = 0.288). Sixteen (30.2%) patients with synovial sarcoma had pain before development of a swelling compared to two (3.6%) patients with other sarcomas (P < 0.001, odds ratio = 11.68, 95% confidence interval 2.53, 53.83). The mean duration of such pain was 37 months (median 24, range 6–120 months). The nature of the pain was variable. Eight patients had sharply localised tenderness. Calcification seen in the X-rays of four patients was initially misdiagnosed as benign lesions. A swelling was ultimately detected by MRI, CT, ultrasound or at physical examination. The mean duration from first presentation with pain till diagnosis of synovial sarcoma was 20 months. In three patients, at explorative surgery there was friable, vascular or necrotic tissue in the absence of a well-defined tumour mass.

Discussion: The occurrence of long-standing pain at the tumour site prior to development of a swelling is significantly more common with synovial sarcomas than with other sarcomas. Awareness of this unusual presentation and appropriate investigation may enable detection of synovial sarcoma at a prognostically favourable early stage.

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Selected References

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  1. Bergh P., Meis-Kindblom J. M., Gherlinzoni F., Berlin O., Bacchini P., Bertoni F., Gunterberg B., Kindblom L. G. Synovial sarcoma: identification of low and high risk groups. Cancer. 1999 Jun 15;85(12):2596–2607. doi: 10.1002/(sici)1097-0142(19990615)85:12<2596::aid-cncr16>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  2. Brodsky J. T., Burt M. E., Hajdu S. I., Casper E. S., Brennan M. F. Tendosynovial sarcoma. Clinicopathologic features, treatment, and prognosis. Cancer. 1992 Jul 15;70(2):484–489. doi: 10.1002/1097-0142(19920715)70:2<484::aid-cncr2820700217>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  3. CADMAN N. L., SOULE E. H., KELLY P. J. SYNOVIAL SARCOMA; AN ANALYSIS OF 34 TUMORS. Cancer. 1965 May;18:613–627. doi: 10.1002/1097-0142(196505)18:5<613::aid-cncr2820180510>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  4. Haagensen C. D., Stout A. P. Synovial Sarcoma. Ann Surg. 1944 Dec;120(6):826–842. doi: 10.1097/00000658-194412000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hirsch R. J., Yousem D. M., Loevner L. A., Montone K. T., Chalian A. A., Hayden R. E., Weinstein G. S. Synovial sarcomas of the head and neck: MR findings. AJR Am J Roentgenol. 1997 Oct;169(4):1185–1188. doi: 10.2214/ajr.169.4.9308488. [DOI] [PubMed] [Google Scholar]
  6. Ichinose H., Derbes V. J., Hoerner H. Cutaneous pain without tumor: a manifestation of occult synovioma. Cutis. 1978 Jan;21(1):74–78. [PubMed] [Google Scholar]
  7. Ichinose H., Wickstrom J. K., Hoerner H. E., Derbes V. L. The early clinical presentation of synovial sarcoma. Clin Orthop Relat Res. 1979 Jul-Aug;(142):185–189. [PubMed] [Google Scholar]
  8. Knazek R. A., Yee C. L., Costa J. Prostaglandin and hydroxyeicosatetraenoic acid synthesis by human mesenchymal tumors. Int J Cancer. 1985 Aug 15;36(2):143–152. doi: 10.1002/ijc.2910360204. [DOI] [PubMed] [Google Scholar]
  9. Maxwell J. R., Yao L., Eckardt J. J., Doberneck S. A. Case report 878: Densely calcifying synovial sarcoma of the hip metastatic to the lungs. Skeletal Radiol. 1994 Nov;23(8):673–675. doi: 10.1007/BF02580396. [DOI] [PubMed] [Google Scholar]
  10. Mullen J. R., Zagars G. K. Synovial sarcoma outcome following conservation surgery and radiotherapy. Radiother Oncol. 1994 Oct;33(1):23–30. doi: 10.1016/0167-8140(94)90082-5. [DOI] [PubMed] [Google Scholar]
  11. Oda Y., Hashimoto H., Tsuneyoshi M., Takeshita S. Survival in synovial sarcoma. A multivariate study of prognostic factors with special emphasis on the comparison between early death and long-term survival. Am J Surg Pathol. 1993 Jan;17(1):35–44. [PubMed] [Google Scholar]
  12. Osaka S., Fujimoto Y., Yamazaki H., Suzuki K., Sawada S., Hayashi N. Interleukin-1 alpha producing synovial sarcoma with prolonged fever: a case report. Jpn J Clin Oncol. 1998 Jul;28(7):436–440. doi: 10.1093/jjco/28.7.436. [DOI] [PubMed] [Google Scholar]
  13. Tsuji F., Oki K., Senda T., Horiuchi M., Mita S. Effects of mitogen-activated protein kinase inhibitors or phosphodiesterase inhibitors on interleukin-1-induced cytokines production in synovium-derived cells. Immunol Lett. 1999 Jun 1;68(2-3):275–279. doi: 10.1016/s0165-2478(99)00051-6. [DOI] [PubMed] [Google Scholar]
  14. Wright P. H., Sim F. H., Soule E. H., Taylor W. F. Synovial sarcoma. J Bone Joint Surg Am. 1982 Jan;64(1):112–122. [PubMed] [Google Scholar]
  15. el-Naggar A. K., Ayala A. G., Abdul-Karim F. W., McLemore D., Ballance W. W., Garnsey L., Ro J. Y., Batsakis J. G. Synovial sarcoma. A DNA flow cytometric study. Cancer. 1990 May 15;65(10):2295–2300. doi: 10.1002/1097-0142(19900515)65:10<2295::aid-cncr2820651022>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]

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