背景:我们介绍了一例罕见的胫神经滑膜肉瘤(SS)患者。到目前为止,文献中只有4例起源于胫神经的SS患者,我们的病人是第二位在治疗过程中肢体得到挽救的病人.滑膜肉瘤是恶性间质瘤,即,结缔组织引起的肿瘤。滑膜肉瘤占所有软组织肉瘤的5-10%。然而,滑膜肉瘤这个名字具有误导性,因为肿瘤不是来源于滑膜细胞,而是来自原始间充质细胞。这个名字很可能起源于四肢大关节周围的定位,更常见的是较低的,在膝关节区域。我们指出了正确和快速诊断以及后续治疗的方面,这对患者的预后有非常重要的影响。未经活检证实的原发性根治较少切除会导致局部复发的风险较高。即使在活检证实肉瘤后立即进行了适当的再切除。
方法:一位出生于1949年的女性在2020年底开始遭受左内踝下疼痛加剧,鞋底和手指突出。她的个人,家庭工作和社会历史微不足道。在最初的神经检查之后,病人被送去做脚踝超声检查,显示50×22×16毫米的小叶肿块,根据磁共振成像,这个发现似乎是一个可疑的胫神经神经瘤。肿瘤是手术切除的,未经活检证实:在tar管远端解剖了一个50×20mm的肿瘤,它通过胫神经的结构生长,并在某些地方进入周围区域,在术中表现为神经纤维瘤。但是从组织学上讲,肿瘤被归类为单相滑膜肉瘤。该患者适用于广泛切除皮肤,皮下组织大小为91×20×15mm。现在,患者正在接受肿瘤床的外部放射治疗,并且能够行走。
结论:本报告提请注意一种罕见的恶性神经肿瘤,在临床和放射学上都可以模拟良性周围神经鞘瘤。滑膜肉瘤应该被认为是非常痛苦的抵抗,通常位于下肢的关节周围,它的增长可能很慢。因为肿瘤的大小是一个负面的预后因素,有必要使用MR成像和组织学活检进行及时诊断,并迅速开始治疗。手术治疗应仅在活检和组织学检查肿瘤后进行,以使其足够彻底,不必进行额外的再手术。就像我们的病人一样。
BACKGROUND: We present the
case of a patient with a rare synovial sarcoma (SS) of the tibial nerve. So far, only 4 cases of patients with SS originating from the tibial nerve have been described in the literature, and our patient is only the second patient whose limb was saved during treatment. Synovial sarcomas are malignant mesenchymal tumors, i.e., tumors arising from connective tissue. Synovial sarcomas account for 5-10% of all soft tissue sarcomas. However, the name synovial sarcoma is misleading, because the tumor does not originate from synovial cells, but rather from primitive mesenchymal cells. The name most likely originated from the localization around the large joints on the limbs, more often on the lower ones, in the area of the knee joints. We point out the aspects of correct and quick diagnosis and subsequent treatment, which has very important effect on the patient\'s prognosis. Primary less radical excision without prior biopsy verification leads to a higher risk of local recurrence, even if a proper reexcision was performed immediately after biopsy verification of the sarcoma.
METHODS: A woman born in 1949 began to suffer at the end of 2020 with escalating pain under the left inner ankle with a projection to the sole and fingers. Her personal, family work and social history were insignificant. After the initial neurological examination, the patient was sent for an ultrasound examination of the ankle, which showed a lobular mass measuring 50 × 22 × 16 mm and according magnetic resonance imaging, the finding appeared to be a suspicious neurinoma of the tibial nerve. The tumor was surgically excised, without prior biopsy verification: a 50 × 20 mm tumor was dissected in the distal part of the tarsal canal, which grew through the structure of the tibial nerve and in some places into the surrounding area and appeared intraoperatively as a neurofibroma. But histologically the tumor was classified as monophasic synovial sarcoma. The patient was indicated for a wide reexcision of the skin with the subcutaneous tissue of size 91 × 20 × 15 mm. Now the patient is being treated with external radiotherapy to the tumor bed and she is able to walk.
CONCLUSIONS: This report draws attention to a rare type of malignant nerve tumor, which both clinically and radiologically can mimic benign peripheral nerve sheath tumors. Synovial sarcoma should be considered in very painful resistances, typically located around the joints of the lower limbs, the growth of which can be slow. Because the size of the tumor is a negative prognostic factor, it is necessary to make a timely diagnosis using MR imaging and a biopsy with histological examination and to start treatment quickly. Surgical treatment should take place only after a biopsy with histological examination of the tumor so that it is sufficiently radical and does not have to undergo an additional reoperation, as happened in the
case of our patient.