Synoviomas are the collective name for a group of tumors that are localized in tendon and synovial sheaths, joint capsules and on the mucous membranes belonging to these anatomical structures. According to the oncological classification proposed by P. Canoso, synoviomas are included in the group of articular tumors with synovial differentiation.
- Types of synovioma
- Etiology
- Classification of synovioma
- Symptoms of synovioma
- Diagnostics
- Treatment of synovioma
- Forecast
Types of synovioma
First of all, it should be noted that synoviomas, based on the nature of their growth, the aggressiveness of the clinical picture and the tendency to metastasize, are divided into benign and malignant. In clinical practice, tumors are often encountered that are in one way or another associated with the synovial vagina, and then we need to talk about a benign form of synovioma. If the oncological process develops in soft tissues, and not necessarily localized near the joints, and progresses quickly, then a malignant form must be suspected - synovial sarcoma.
The existence of benign synoviomas is disputed by a number of authors. Some scientists argue that all diseases from this group have a malignant course, and it does not depend on the degree of maturity of the tumor. In a number of cases, biopsy material taken from a pathological focus reveals atypical elements in the form of giant cells, which gives grounds to divide benign synoviomas into 2 types: without giant cells and giant cell (according to the WHO classification, the latter condition corresponds to nodular tenosynovitis and does not apply to blastomas ).
G. Gailer purposefully studied synoviomas, who described cases of the benign course of the tumor. He gave as an example hard nodules that were localized near the joints and were surrounded by a clear capsule. Microscopically, they were a cluster of fibroblast-like and epithelial-like cells (the so-called biphasic structure), which most closely resembled mature synoviocytes.
Citing the example of a microscopic picture of a tumor, the scientist still argued that whether a process is benign should be judged not only by the results of microscopy, but also by the clinic, and suggested monitoring such patients for at least 5 years.
Synovioma in children
The disease practically never occurs in childhood. If diagnosed, the tumor could arise as a result of the carcinogenic effects of various factors on the woman’s body during pregnancy or directly on the child after his birth. Hereditary predisposition and the presence of cancer pathology in close relatives play a significant role. The symptoms and principles for diagnosing synovioma of the tendons, fingers, shoulders and other types are similar to those in adults. Treatment is selected by the doctor taking into account the child’s age, stage of cancer, and individual characteristics of the body.
Classification of synovioma
If we consider the histological signs of tumor-like neoplasms of the synovial vagina, then synovioma can be divided into the following types:
- fibrous with a predominance of fibrous structures;
- giant cell with the presence of cells resembling osteoclasts;
- alveolar with the presence of cyst-like vesicles;
- adenomatous in structure similar to glandular tissue;
- mixed.
Exophytic growth is characteristic of a more favorable, benign course of synoviomas. With it, the formation of a dense node is observed, which has a capsule and pushes aside neighboring tissues. If the tumor does not have a clear boundary, it grows into neighboring areas, has an uneven, bumpy surface, then they speak of endophytic tumor growth and a malignant process.
Symptoms
Typically, synovioma does not cause significant discomfort to patients. It is a tumor with the following clinical signs:
- nodular or nodular-lobulated formation;
- dense consistency;
- about 1 – 2 cm in size;
- found on the fingers or in the area of the knee and wrist joints;
- painless or slightly painful when palpated;
- almost does not move;
- separated from the tissues surrounding it;
- no changes in the skin over the tumor;
- Functional disorders of the fingers or joints are extremely rare.
Symptoms of synovioma
Benign synovioma is characterized by scanty clinical manifestations. The disease occurs mainly in people under 45 years of age. The size of the formation of a soft or dense consistency usually does not exceed 20 mm (with a benign course), and patients are more concerned about the cosmetic defect. Pain during movement and at rest occurs quite rarely, unless a nearby nerve is involved in a pathological process or is compressed by a growing tumor. Synovioma can cause minor disturbances in motor functions in the projection of the affected joint (flexion, extension, pronation, supination, rotation worsen). As the tumor grows rapidly, symptoms may worsen.
In malignant synovial sarcoma, the course of the disease is characterized by rapid growth, involvement of nearby tissues in the process, severe pain and the risk of metastases.
Specific symptoms may be accompanied by general signs of a tumor process (especially with synovial sarcoma): weakness, loss of appetite, malaise during the day, rapid fatigue, weight loss. With metastasis to the lymph nodes, their increase is noted.
Causes of synovioma
The pathogenesis of the disease lies in the disruption of the formation of normal synovial cells during their reproduction due to atypical transformations. The following conditions may be the possible etiological factors:
- unfavorable environmental conditions;
- mutational defects encoded in the genetic code that are inherited;
- exposure to radiation, ultraviolet radiation;
- consumption of foods that contain carcinogenic substances;
- traumatic damage to joints;
- long-term exposure to carcinogens of physical and chemical origin.
Diagnostics
A mandatory method of instrumental research is radiography, which will allow for preliminary differential diagnosis with joint diseases. It is advisable to conduct the study in two projections in order to examine the topography of the tumor relative to adjacent elements. The image shows a slight darkening, which is typical for soft tissue formations. Synovioma is usually semicircular in shape, pushes aside surrounding tissues, and has clear contours (with a benign course).
Angiography helps visualize the vasculature near the synovioma. Some blood vessels “break off” near the tumor due to compression by the growing tumor. Puncture of the synovial bursa has a certain diagnostic value. By examining the obtained synovial fluid, it is possible to detect atypical cells and signs of hemorrhage, which makes it possible to distinguish a neoplastic process from an inflammatory process (synovitis).
The most informative method is a biopsy of a tumor formation, the results of which are most often decisive for making a diagnosis. Microscopic examination of the biopsy specimen can differentiate the histological types of synovioma. However, performing a biopsy is fraught with increased tumor growth, so it must be approached with caution.
Diagnosis of synovioma
The diagnosis is made by doctors of rheumatology and oncology specialization. They conduct a thorough interview of the patient, find out the anamnestic data, find out the presence of risk factors and prescribe additional laboratory and instrumental examinations, the list of which includes the following appointments:
- X-ray of the pathological focus - on X-ray, synovioma looks like a tumor-like neoplasm;
- angiography of the affected area - study of the vascular network and blood circulation in the pathological focus;
- examination using strontium radioisotopes;
- biopsy of affected tissues - cytological and histological analysis of the obtained samples is carried out, the presence of cysts and cleft-like spaces is noted, giant cell synovioma of the foot, spine, finger, hip, knee or other localization can be identified;
- MRI for synovioma can identify both the tumor itself and distant lesions.
When the disease progresses to the stage of metastases, distant foci can be identified using lymph node puncture, as well as ultrasound, X-ray diagnostic procedures, and scintigraphy.
Forecast
Due to the slow growth and “maturity” of tumor cells, the prognosis is favorable in most cases. However, relapses of synovioma can occur in approximately 40% of cases, especially when the tumor location is difficult to access for tissue excision and the desire to preserve limb function as much as possible after surgical treatment.
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Synovioma prognosis
When a benign formation in the joint area is diagnosed, after surgery to excise it, patients are slightly at risk of complications and relapses, that is, they have a relatively favorable prognosis.
Malignant synovioma is dangerous with a high probability of metastasis. More than fifty percent of patients, after undergoing specific therapy, again sought medical help with a relapse of the disease. In this case, an important aspect is timely diagnosis and treatment, which, however, does not guarantee a complete recovery.
Prevention
Currently, there are no special measures to prevent such neoplasms, since there is no exact explanation of the reasons for the onset of synovioma development. However, if you follow some simple recommendations, you can reduce the likelihood of their occurrence. It is necessary to avoid any injuries to the limbs, protect yourself from exposure to radiation and harmful substances, and follow safety and protection rules when contacting chemicals. Persons with a genetic predisposition to such diseases must undergo regular medical examinations, laboratory and instrumental examinations.
Treatment
The most effective method of treating synovioma is complete surgical removal of the tumor. Depending on the complexity of the disease, the degree of surgical intervention during the operation varies. For small tumors, 3-5 cm of healthy tissue surrounding the tumor is excised. If the tumor is advanced and has reached a large size, then fairly large areas of adjacent soft tissue, bones and lymph nodes are excised. In particularly severe cases, the limb is amputated.
Radiation therapy is used before and after surgery. Before surgery, it is needed to stop the growth of the tumor and prepare it for excision. After surgery, it helps prevent complications and re-development of the tumor.
Chemotherapy is used in cases where the tumor is diagnosed late and has extensive metastases. Chemotherapy treatment is often used to increase the effectiveness of other methods or in cases where the tumor is at a late stage of development and it is impossible to operate on it.
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Symptoms
One of the first symptoms of synovioma development is the appearance of a tumor, which can most often be detected by touch. Typically, such neoplasms are of medium density, but they can also be hard. The appearance of pain is a significant symptom of the development of a malignant process. Synovioma of the elbow, shoulder or knee joint limits their mobility. In cases where the tumor compresses the nerve, numbness of the limbs may occur. There are also general signs of the disease that do not depend on the location of the tumor. The patient feels unwell, feels weak and constantly tired, loses appetite, loses weight sharply, body temperature rises, and lymph nodes enlarge.