Premonitory Pain Preceding Swelling: A Distinctive ClinicalPresentation of Synovial Sarcoma which may Prompt Early Detection

摘要

Purpose:The aim of this paper is to document the unusual presentation of long-standing pain at the tumour site beforedevelopment 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 randomlyselected 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 withother sarcomas (P< 0.001, odds ratio = 11.68, 95% confidence interval 2.53, 53.83). The mean duration of such pain was37 months (median 24, range 6–120 months). The nature of the pain was variable. Eight patients had sharply localisedtenderness. Calcification seen in the X-rays of four patients was initially misdiagnosed as benign lesions. A swelling wasultimately detected by MRI, CT, ultrasound or at physical examination. The mean duration from first presentation with paintill diagnosis of synovial sarcoma was 20 months. In three patients, at explorative surgery there was friable, vascular ornecrotic 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 morecommon with synovial sarcomas than with other sarcomas. Awareness of this unusual presentation and appropriateinvestigation may enable detection of synovial sarcoma at a prognostically favourable early stage.