SHM Converge Scientific Abstract ePoster Gallery-Biphasic Synovial Sarcoma: A Spark in a Tinderbox

Pdf Summary

This case describes a 45-year-old man with rapidly progressive biphasic synovial sarcoma of the right distal femur/knee. He initially presented with only two weeks of knee pain and inability to bear weight, without constitutional symptoms. MRI showed a large intramedullary mass with cortical breakthrough, and CT of the chest, abdomen, and pelvis revealed multiple bilateral pulmonary nodules consistent with metastatic disease. Biopsy confirmed biphasic synovial sarcoma, and FISH demonstrated the characteristic t(X;18) translocation involving the SS18 gene.<br /><br />Two weeks later, the patient returned with severe dyspnea and was found to have acute hypercapnic respiratory failure. Imaging showed bilateral large pleural effusions and enlarging pulmonary nodular masses in a “cannonball” metastatic pattern. Thoracentesis drained 1.5 L of hemorrhagic exudative pleural fluid. After brief improvement, he was started on palliative-intent chemotherapy with doxorubicin, ifosfamide, and mesna (AIM), but his mental status worsened during treatment. Following discussion with family, care was transitioned to comfort measures, and he was palliatively extubated and discharged to inpatient hospice.<br /><br />The report emphasizes that synovial sarcoma is a rare but highly aggressive malignancy, often seen in younger adults, with early metastatic spread and significant morbidity. Although anthracycline-based chemotherapy is standard first-line treatment for metastatic disease, outcomes remain poor in advanced cases. The authors highlight the importance of early diagnosis, rapid multidisciplinary involvement, and the need for more effective systemic therapies.

Asset Subtitle

Ahmed Qaedi

Meta Tag

Author List Ahmed Qaedi, Amin Demerdash, Claudia Warden, Hope Lackey, Srilakshimi Bathini

Category Clinical Vignettes

Concept Synovial Sarcoma

Concept tX18 Translocation

Concept Distant Metastasis

Concept Biphasic Synovial Sarcoma

Concept Mesenchymal Malignancy

Distinguished Non-Finalist

Presenter Organization University of Alabama at Birmingham, Huntsville Regional Medical Campus

Presenting Author Ahmed Qaedi

Track Adult

Keywords

synovial sarcoma

biphasic

distal femur

knee pain

pulmonary metastases

SS18 translocation

acute respiratory failure

pleural effusion

doxorubicin ifosfamide mesna

palliative care

Synovial Sarcoma

tX18 Translocation

Distant Metastasis

Biphasic Synovial Sarcoma

Mesenchymal Malignancy