De Silva MVC, Barrett A, Reid R. Premonitory Pain Preceding Swelling: A Distinctive Clinical Presentation of Synovial Sarcoma which may Prompt Early Detection.
Sarcoma 2011;
7:131-5. [PMID:
18521377 PMCID:
PMC2395526 DOI:
10.1080/13577140310001644788]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of this paper is to document the unusual presentation of long-standing pain at the tumour site before
development of a swelling in patients with synovial sarcoma.
Patients/methods and results: The clinical presentation of 53 patients with synovial sarcoma was compared with 56 randomly
selected patients with other sarcomas of the trunk and extremities. The two groups were similar with regard to age
(P = 0.980), sex (P = 0.784) duration of symptoms
(P = 0.697), size (P = 0.931) and site of tumour (P = 0.288). Sixteen
(30.2%) patients with synovial sarcoma had pain before development of a swelling compared to two (3.6%) patients with
other sarcomas (P < 0.001, odds ratio = 11.68, 95% confidence interval 2.53, 53.83). The mean duration of such pain was
37 months (median 24, range 6–120 months). The nature of the pain was variable. Eight patients had sharply localised
tenderness. Calcification seen in the X-rays of four patients was initially misdiagnosed as benign lesions. A swelling was
ultimately detected by MRI, CT, ultrasound or at physical examination. The mean duration from first presentation with pain
till diagnosis of synovial sarcoma was 20 months. In three patients, at explorative surgery there was friable, vascular or
necrotic tissue in the absence of a well-defined tumour mass.
Discussion: The occurrence of long-standing pain at the tumour site prior to development of a swelling is significantly more
common with synovial sarcomas than with other sarcomas. Awareness of this unusual presentation and appropriate
investigation may enable detection of synovial sarcoma at a prognostically favourable early stage.
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