Synovial sarcoma presenting as a primary bone tumor
Synovial sarcoma typically presents as periarticular soft tissue mass in adolescent and young adult patients. Very rarely, soft tissue sarcomas may arise primarily within bone posing a significant diagnostic challenge as primary osseous malignancies such as osteosarcoma and metastatic disease are much more common.

While tissue sampling with immunohistochemical and genetic testing are required for definitive diagnosis, radiologists and orthopedic oncologists should consider alternate etiologies when typical imaging features of more common bone tumors are not identified.

As an example, published in the journal Radiology Case Reports, the authors present a case of a 33-year-old male referred with a pathologic hip fracture proven to represent primary synovial sarcoma of bone.

A 33-year-old male was referred for evaluation and treatment of a proximal femoral lesion. Past medical history was pertinent only for remote trauma resulting in right femur fracture requiring retrograde intramedullary nail fixation. Two years prior to the current presentation, he was seen by a community orthopedic surgeon for hip pain.

Hip arthroscopy at that time identified a labral tear which was repaired (details of the visit and procedure are otherwise unavailable). The patient stated that hip pain worsened over the following years at which point his surgeon recommended MRI of the hip.

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