Synovial Sarcoma of Hand with Unexpected Presentations Mimicking that of a Neurilemomma - Case Report and Review of Literature

手部滑膜肉瘤模仿神經母細胞瘤－病例報告和文獻回顧

吳宗翰(John Chung-Han Wu) ； 周邦昀(Pang-Yun Chou) ； 王柏方(Po-Fang Wang) ； 陳宏基(Hung-Chi Chen) ； 陳思恆(Shih-Heng Chen)

《臺灣整形外科醫學會雜誌》 27卷3期 (2018/09) Pp. 198-205

摘要

Background: Synovial sarcomas of the hand are extremely rare but have a worse prognosis than do most soft-tissue sarcomas. This condition is often misdiagnosed because of its insidious growth pattern, variable tumor size, benign radiographic appearance, and frequent pain-eliciting characteristics, which are similar to those of common trauma. Aim and Objectives: We present the case of a patient with synovial sarcoma of the hand and describe its clinical presentation, treatment course, pathological characteristics and prognosis. Materials and Methods: A 45-year-old man presented with a progressive enlarging mass in his right palm along with tingling sensations over his right ring finger, leading to the tentative diagnosis of a neurilemmoma. Image studies revealed no adjacent local invasions or multiple masses under different phases and sections. Therefore wide-excision surgery was performed with a 2cm safety margin and pathology later revealed the diagnosis of synovial sarcoma. Results: Because of the highly aggressive and malignant nature of this sarcoma, postoperatively, the patient underwent chest and abdominal computed tomography (CT), whole-body bone scan, and whole-body fludeoxyglucose-18 positron emission tomography (F-18 FDG PET) to rule out metastasis, which all came back negative. Adjuvant radiotherapy, including the tumor excision site as well as a 2-cm margin, was performed at 2 months postoperatively. The patient has been followed up for six months with no signs of distant metastasis or local recurrence as well as no complaints regarding functional or aesthetic deficits. Conclusion: We described the development of synovial sarcoma of the hand, a rare yet highly malignant disease, in a patient presenting with symptoms mimicking those of a neurilemmoma. Early diagnosis and treatment of this condition are crucial for increasing overall life expectancy and limb preservation.

關鍵字

hand ； neurilemomma ； synovial sarcoma ； soft tissue sarcoma

並列摘要

背景：長在手部的滑膜肉瘤極少見，但其預後遠比大多數軟組織肉瘤差。由於其生長方式隱蔽，腫瘤大小不等，良性放射影像學表現，及其疼痛特徵與創傷後疼痛類似，故常常被誤診或延後診斷。目的及目標：我們介紹手部滑膜肉瘤患者的病例，並描述其臨床表現，治療過程，病理特徵和預後。材料及方法：一名45歲的男子在右手掌中出現一個漸進性擴大的腫塊，伴隨著他右手無名指的刺痛感，因此初步診斷為神經鞘瘤。影像檢查顯示並沒有局部的侵入或多顆腫瘤。因此我們進行了兩公分安全範圍的腫瘤的廣泛性切除手術。病理報告最後顯示該腫瘤為惡性的滑膜肉瘤。結果：由於該肉瘤具有高度侵襲性和惡性特徵，因此患者術後接受了胸部和腹部的電腦斷層掃描（CT），全身骨掃描和全身型脫氧葡萄糖18正電子發射斷層掃描（F-18 FDG PET），而所有的影像檢查結果都證實該病患並沒有遠端轉移。在術後2個月時，病患進行了輔助性放射治療，包括腫瘤切除部位以及2cm的邊緣。目前患者已在手術後追蹤了6個月，並且沒有遠處轉移或局部復發跡象，也沒有關於功能或美學缺陷的抱怨。結論：我們描述了手部滑膜肉瘤的個案報告。這是一種極度罕見但是高度惡性的疾病，然而它在這個病患的表現卻模擬神經鞘瘤的症狀。這種疾病的早期診斷和治療可以提高總體預期壽命以及提高肢體保存的機率。