Primary Tibial Synovial Sarcoma: Uncommon Tumour on Uncommon Site –Case Reports
Muhammad Muzzammil, Muhammad Saeed Minhas, Anisuddin Bhatti, Adnan Hussain Muhammad Ovais, Abdul Qadir, Ayesha Mughal, Syed Jahanzeb
Objective:To report the clinical characteristic of primary tibial synovial sarcoma, in terms of aggressiveness, local spread/ metastasis, surgical procedures and final outcome.
Methods:3 case reports conducted and diagnosed in last 10 years were included and examine clinically as well radiologically. and ultimate surgical procedures performed and post operative follow up were studied and recorded. Patients diagnosed and procedures performed at other centre were excluded. All three patients underwent wide surgical excision and reconstruction with non vascularized fibular graft. Clinical and radio graphical follow up of 3 years done to see any recurrence and other complications.
Results: three cases of primary tibial synovial sarcoma diagnosed in study period, all of them were female and in teen age, 2 were of 17 years and one 19 years old. One case of 19 years female present with history of 1 year of swelling and pain of leg.Second and third case of 17 years age present with history of 6 and 9 months respectively of mass and pain in leg respectively. All cases were examined, investigated and biopsy done showed synovial sarcoma, followed by Wide local excision done, non-vascularized graft from fibula of opposite leg placed and anti rotatory screw applied in first case and Non-vascularized graft from fibula of opposite leg and fixation with inter-medullary k-wire and butteress T plate done in second and third case. Wound covered with rotational flap in all three cases followed by chemotherapy. No complication or recurrence noted in 3 years follow-up.
Conclusion: Primary Synovial sarcoma of bone is rare tumour and rarely occurs at tibia, with a tendency to occur in young adults and chemotherapy sensitivity. These case reports shows good outcome in management of synovial sarcoma with wide local excision and chemotherapy.
Key Words: Synovial sarcoma, tibia, chemotherapy, resection, fibular graft.