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1 Department of Radiology, Keller Army Community Hospital, 900 Washington Rd.,
West Point, NY 10996-1197.
2 Department of Pathology, Walter Reed Army Medical Center, 6900 Georgia Ave.,
Washington, DC 20307-5001.
3 Department of Surgery, Keller Army Community Hospital, West Point, NY
10996-1197.
Received February 4, 2002;
accepted after revision March 4, 2002.
The opinions and assertions contained herein are those of the authors and
should not be construed as official or as representing the opinions of the
Department of the Army or the Department of Defense.
Introduction
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Synovial sarcoma arises from undifferentiated mesenchymal tissue, accounting for approximately 5-10% of all malignant mesenchymal neoplasms [1]. Synovial sarcoma is a misnomer because the tumor does not arise from the synovium; it only resembles synovial tissue at light microscopy. Histologically, the tumor is biphasic, composed of both epithelial and spindle cell components in varying proportions. Special immunohistochemical markers show the presence of vimentin and cytokeratin. A consistent, specific translocation, most commonly a balanced reciprocal translocation, t(X;18)(p11.2;q11.2), is found in more than 90% of all synovial sarcomas (as in our patient). The translocation involves the SYT gene on chromosome 18 and either the SSX1 or SSX2 gene on the X chromosome. The SYT and SSX fusion messenger RNA can be detected by reverse transcriptase polymerase chain reaction, as was done in our patient, or fluorescent in situ hybridization using formalin-fixed paraffin-embedded or frozen tissue.
Most (80-95%) synovial sarcomas occur in the extremities, presenting as palpable masses. Synovial sarcomas rarely involve the chest wall [2, 3].
MR imaging is the radiologic examination of choice for evaluating synovial sarcoma, which has a "bowl-of-fruit" mixed signal appearance. Areas of hyperintensity on T1- and T2-weighted images correspond to areas of hemorrhage and hematoma. Areas of hypointensity on T1- and T2-weighted images correspond to viable fibrous tissue of the tumor. Areas of hypointensity on T1-weighted images and hyperintensity on T2-weighted images also correspond to viable portions of the tumor. Fluid—fluid levels are seen in 10-25% of synovial sarcomas on MR imaging, corresponding to areas of hemorrhage [1].
The fluid—fluid level was initially thought to be specific for aneurysmal bone cyst. Subsequently, the fluid—fluid level was reported in various bone neoplasms (fibrous dysplasia, simple bone cyst, malignant fibrous histiocytoma, metastasis, chondroblastoma, giant cell tumor, osteosarcoma) and soft-tissue neoplasms (hemangioma, synovial sarcoma) [4].
Treatment of synovial sarcomas is wide-to-radical resection with or without radiotherapy.
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  J.-J. Hung, T.-Y. Chou, C.-H. Sun, J.-S. Liu, and W.-H. Hsu Primary synovial sarcoma of the posterior chest wall. Ann. Thorac. Surg., June 1, 2008; 85(6): 2120 - 2122. [Abstract] [Full Text] [PDF]
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