gms | German Medical Science

Objectives/Interrogation: Soft tissue sarcoma (STS) of the hand is rare. To achieve the best possible functional and cancer-related outcomes, surgical excision must be combined with early reconstructive surgery and multidisciplinary care.

Methods: A 30-year-old man was presented complaining of painless mass over thumb finger of the right hand. At physical examination he had pulsatile pain over the thenar eminence and positive Tinel sign. Ultrasonography and MRI study showed a highly 2 cm vascularized nodule. Extirpation was carried out, showing compression of the tenar motor branch of the median nerve and both collateral nerves of the thumb. Pathological anatomy (PA) and immunohistochemically proved diagnosis of synovial sarcoma grade 2 of the FNCLCC system. Local study was performed and malignant edge was observed. No malignant extension lesions were identified. Surgical block resection was performed including thenar musculature, both collaterals and ulnar collateral bundle. ALT flap of the left limb was used to covered the skin defect. PA confirmed the diagnosis of synovial sarcoma and treatment with adjuvant RT was completed. The patient had a good functional outcome and at 6 months of follow-up no local or distance recurrence is observed.

Results and Conclusions: Synovial sarcoma is one of the most misdiagnosed malignancies of soft tissues, due to slow growing pattern,benign radiological features and pain similar to traumatic pain. STS are initially diagnosed as myositis, haematoma, synovitis, bursitis and delay in diagnosis is common. There is no significant correlation between previous surgical excision and risk of local recurrence. According to Gaurish SKS et al. regional lymph node dissection is not required. Treatment involves excision with a margin of clearance (1-2 cm) followed by reconstruction. Success reconstruction is determined by stable wound coverage, preservation of health, function and sensation. Free flaps offer durable and well-vascularized tissue of sizes greater than those achievable with local or regional flaps. They can provide coverage of vital anatomical structures, as well as minimize the effects of radiation injury on these structures. Awareness of this rare tumor can hasten diagnosis, and this can increase survival. Therefore, a high index of suspicion should be kept in mind, particularly when evaluating young people. Physical examination as well as correct imagen tests, would improve the diagnosis, associated with a multidisciplinary care.