滑膜肉瘤 Synovial Sarcoma
Synovial sarcoma is the fourth most common malignant primary soft-tissue neoplasm. The radiologic manifestations and spectrum of synovial sarcoma reflect the underlying pathologic appearance. Although the radiographic characteristics of synovial sarcoma are not pathognomonic, the findings of a soft-tissue mass, particularly if calcified, near but not in a joint in a young patient (15–40 years of age) are very suggestive of this diagnosis.Cross-sectional imaging features are vital for staging extent and for planning surgical resection. They also frequently reveal suggestive appearances of multilobulation and marked heterogeneity (creating the triple sign) with hemorrhage, fluid levels, and septa (creating the bowl of grapes sign). Two features associated with synovial sarcoma that may lead to an initial mistaken diagnosis of a benign indolent process are slow growth (average time to diagnosis, 2–4 years) and small size (5 cm at initial presentation); in addition, these lesions may demonstrate well-defined margins and homogeneous appearance on cross-sectional images. Synovial sarcoma is an intermediate- to high-grade lesion, and, despite initial aggressive wide surgical resection, local recurrence and metastatic disease are common and prognosis is guarded. Understanding and recognizing the spectrum of radiologic appearances and their pathologic bases allow improved patient assessment and are important for optimal clinical management.