Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15–40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the “triple sign”), in addition to features like hemorrhage and fluid–fluid levels with septa (resulting in the “bowl of grapes” appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2–4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
滑膜肉瘤是一种罕见且高度侵袭性的软组织肉瘤，主要影响15-40岁的青少年和年轻成人。这类肿瘤通常发生于深部软组织，常见于四肢大关节附近。虽然其影像学特征并不具有绝对特异性，但若软组织肿块（约30%病例可见）邻近关节并伴有钙化，则强烈提示该诊断。横断面影像特征在滑膜肉瘤的诊断中起着关键作用，常呈现多分叶状结构及显著异质性（形成“三重征”），同时可伴有出血、分隔状液-液平等特征（形成“葡萄串征”）。然而，若肿瘤表现出非侵袭性特征，如缓慢生长（平均确诊时间2-4年）、体积较小（初始直径<5厘米）且边界清晰，则可能被误判为良性病变。较大肿瘤体积、较高年龄及肿瘤分级已被确定为局部复发和转移发生的不良预测指标。近期研究阐明了CT与MRI特征对滑膜肉瘤的预后意义，包括无钙化、囊性成分、出血、葡萄串征、三重征及跨间室扩展等因素。广泛手术切除仍是确定性治疗的标准方案。深入认识和识别与预后相关的滑膜肉瘤多样化表现，可能有助于实现最佳的患者管理。
Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis
肿瘤(癌症)患者之家