Radiological features of ankle synovial cell sarcoma
Jihane Habi1,&, Nadia Moussali2
1Department of Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences/Cheikh Khalifa International University Hospital, Casablanca, Morocco, 220 Aout Radiology Department of the Ibn Rochd of Casablanca University, Casablanca, Morocco
Jihane Habi, Department of Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences/Cheikh Khalifa International University Hospital, Casablanca, Morocco
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A 23-years-old man was referred to our institution to investigate
a painless right ankle mass. The clinical examination found a painful
mass, fixed on the superficial and deep plane with vascular turgor.
It measured 15x10cm (A). The X-ray of the ankle was done first
and revealed opacity centred
on the soft external malleolar tissues (arrow B). Then a magnetic
resonance imaging (MRI) was performed. It showed multi lobulated
mass with heterogeneous enhancement
of gadolinium (C) and a specific triple signal in T2 weighted images
(D), made by a hyper signal (liquid), intermediate signal (tumor
hypo signal (septa). This radiological finding reminds a "bowl of grapes".
The extension to the carpal bones was diagnosed as a hyper signal
area on T2 (arrow D). The diagnosis of synovial sarcoma was suggested
and then confirmed
by pathological analysis after performing a surgical biopsy. The
patient has developed a metastatic location in the right thigh.
is a malignant mesenchymal tumor. It presents 10% of all ankle
soft tumors, and affects young adults with a sex ratio of 1. The
lesion is often slow
growing. On MRI, the synovial sarcoma diagnosis strongly suggestive
by the classic "triple sign"; and "bowl of grapes sign" in T2 sequences.
Its treatment is based on surgical excision adjunctive with chemotherapy
Figure 1: illustration of ankle synovial sarcoma (A); radiographic X-ray (B); magnetic resonance imaging (C, D)