Giant synovial sarcoma of the posterior thigh in an adult African male: a case report

Abstract

Case Report: A 65-year-old man presented with 5-month history of a painless progressive posterior right thigh swelling with no impairment of ambulation. Examination revealed a huge mass of the posteromedial thigh measuring 32cm x 24cm x 16cm in the widest dimensions. A provisional diagnosis of soft tissue sarcoma was made and was supported by the magnetic resonance imaging findings of heterogenous consistency of the mass. He had a wide local excision done with a gross tumor free margin and split thickness skin grafting of the residual defect at a second surgery 3 weeks after. The histopathological diagnosis was initially categorized under the broader classification of undifferentiated pleomorphic sarcoma with histologically free tumor margin noted. Immunohistochemical staining further characterized the lesion as poorly differentiated synovial sarcoma. The post-operative recovery was initially smooth with a well-healed defect. However, the patient declined further treatment and died 4 months post-tumor excision from an early aggressive recurrence.

Conclusion: The occurrence of an aggressive, rarely diagnosed, synovial sarcoma in an adult African man is highlighted. A fatal outcome from an aggressive early recurrence occurred despite histologically clear resection margins.