SYNOVIOMA [synovioma; lat. (membrana) of synovialis a synovial membrane + oma] — group of tumors, coming from joints of a synovial membrane, synovial vaginas and synovial bags. Distinguish high-quality and malignant S.
the High-quality synovioma
the High-quality synovioma (the fibroendothelioma of joints, a synovialoma, a sinovio-endothelioma, giant-cell si-nov of ohm, knotty tenosinovit) — the rare tumor, existence a cut is disputed by many researchers taking a giant-cell tumor of vaginas of sinews of muscles for high-quality S. Occurs approximately equally often at men and women, preferential at the age of 20 — 40 years. The hl is localized. obr. in fingers of a brush it is also connected with synovial vaginas. Macroscopically has an appearance uzlovatodolchaty, partially encapsulated, a dense consistence of education to dia. usually 10 — 20 mm. On a section a tumor grayish, it is frequent with sites yellow (due to inclusions of lipids) or brown color (because of deposits of hemosiderin). Microscopically high-quality S. is formed by the fibroblastichesky elements located in the hyalinized coarse-fibered stroma. In a tumor huge multinucleate cells like osteoclasts are unevenly disseminated. Fields of ksantomny cells and accumulation of haemo siderophages meet.
A wedge, manifestations are very poor. Usually the tumor of a maloboleziyenn, does not cause functional disturbances.
Treatment is operational, consists in broad excision of a tumor within healthy fabrics, though as many surgeons note, tumoral nodes are easily enucleated.
Forecast favorable. A recurrence, according to Wright (Page J. E. Wright, 1951) and Jones (F. E. Jones) et al. (1969), are noted in 17 — 43% of cases that is explained by either impossibility of performance of radical operation, or mestnoinfiltriruyushchy growth of a tumor. Cases of a maligiization are described.
The malignant synovioma
the Malignant synovioma (synovial sarcoma, a synovial sarkoendotelioma, a synovial sarkomezotelioma) makes, according to Kadmen (N. L. Cadman, 1965), apprx. 10% of sarcomas of soft tissues. It is found at the age of 20 — 40 years more often, it is preferential at men. Apprx. 70% of malignant S. the hl develops on the lower extremities. obr. in the field of a knee joint, apprx. 20% — on upper extremities, hl. obr. in an elbow joint and a brush. Extremely seldom the tumor is located in a joint.
Macroscopically the tumor has an appearance of the shapeless limited weight, usually large sizes (to 100 mm in dia. and more) which is often surrounded with the pseudo-capsule. Fabric of a tumor on a section by sight homogeneous, a myagkoelastichesky consistence; sometimes in it the sites of a bone, cartilage, calcificats and cysts filled with slizevidiy or hemorrhagic liquid meet. Histologically distinguish two main types of the cells presented to tumors in various ratios: spindle-shaped fibroblastopodobny and a polygonal, cubical or cylindrical form epitet iopodobny cells. Dominance of one of these types of cells allows to speak about preferential monophase option of malignant S., or at rather equal ratio of cells — about bi-phase option of a structure. Existence of the zhelezistopodobny structures and cracks covered by epithelial-like cells with the eosinophilic mutsinopodobny substance in a gleam which is quite often containing hyaluronic to - that is characteristic. From other features of a structure of malignant S. it should be noted existence of fields of a hyalinosis, in to-rykh tumor cells are located in the form of islands, and also the centers of ossification and petrification and besides not in zones of a necrosis as it happens in the majority of sarcomas, and in the sites of collagenization, the centers of a cartilage and structures reminding sinews.
The most frequent a wedge, symptoms are pain and a swelling; functional disturbances, as a rule, are absent or are minimum. Sometimes a wedge, symptomatology it is connected with a prelum or germination of nerves or damage of bones. On a wedge, to a current malignant S., unlike others a rarok of soft tissues has usually long eclipse period (up to 2 years), during to-rogo it the wedge practically does not give in, to diagnosis.
Rentgenol. signs are not characteristic and can meet at other sarcomas of soft tissues and nek-ry not tumoral diseases. With the help rentgenol. researches it is possible to specify localization, the sizes, extent of distribution and a growth form of a tumor. Except a usual X-ray analysis and a tomography of soft tissues with obligatory removal of the interesting site in a krayeobrazuyushchy zone, apply screenless to malignant S.'s diagnosis X-ray analysis (see), electrox-ray analysis (see), artrografiya (see) and at the tumor which is deeply lying in muscles — pneumography (see) and angiography (see). The tumoral node, is more often single, is located, as a rule, near a joint and is rare far from it; has the rounded or oval shape, accurate equal or polycyclic contours with an expansive growth (fig. 1), indistinct contours at malignant S.'s growing into surrounding fabrics and at recurrent tumors. In 30 — 50% of cases against the background of a tumoral node inclusions are defined — small unstructured kaltsinata are more often, large homogeneous sites of ossification are more rare. At a half of patients secondary changes in adjacent bones — an atrophy from pressure, a curvature and drawing apart bones are noted, and at rapid growth a razvolokneniye of kokhmpaktny substance (cortical substance), periosteal reaction, sometimes even like «visor», simulating an osteosarcoma, and lytic destruction up to destruction of several bones. In places of an attachment of the joint capsule and sinews there are uzura of a bone with accurate contours. At an angiography comes to light patol. hyper vascularization of a tumor (fig. 2), edge is characteristic of malignant tumors of soft tissues.
Innidiation preferential hematogenous is also observed, by data to S. i. Hajdu with sotr. (1977), at 73%, and according to Hagensen and Stout (G. D. Haagensen, And. P. Stout, 1944), at 92% of patients. Lymphogenous metastasises, according to Eriel (J. M of Ariel) and J. Pak (1963), come to light in 12%, and according to Wright (1952), in 37% of cases.
Treatment operational — carry out broad excision of a tumor within healthy fabrics or amputation of an extremity (see. Amputation ). There are separate messages on efficiency radiation therapy (see) and chemotherapy (see. Chemotherapy of tumors ), especially adriamycin. However this question demands further studying.
Forecast adverse. According to various researchers, five-year survival makes from 23,5 to 51%. A local recurrence, according to Kadmen (1965), is observed in 28%, and according to Mackenzie (D. N of Mackenzie, 1969) — in 92% of cases.
Bibliography: Vintergalter S. F., Vesnin A. G. and M at r z and B. A N. Radiodiagnosis of tumors of soft tissues, M., 1979; In their ER of A. M. t, and l and l • About of l y G. A. and P about r about K. K. Jpukholi's tires of soft tissues, page 69, M., 1969; Knysh I. T., Thorny K. S. and Borisyuk B. E. Synovial sarcoma, Kiev, 1975, bibliogr.; To about 1 a r J. The radiological characteristic of calcification at a malignant synovioma, Vestn. rentgenol. and radio-gramophones., No. 3, page 35, 1973, bibliogr.; Rukavishnikova V. G. About malignant giant-cell synoviomas, Vopr. onkol., t. 21, No. 7, page 37, 1975, bibliogr.; With adman N. L., Soule E. H. a. Kelly P. J. Synovial sarcoma, Cancer, v. 18, p. 613, 1965; Hajdu S. I., Shiu M. H. a. Fortner J. G. Tendosynovial sarcoma, ibid., v. 39, p. 1201, 1977; Jones P. E., Soule E. H. a. Coventry M. B. Fibroux xanthoma of synovium, J. Bone Jt Surg., v. 51-A, p. 76, 1969; Macke n-z i e D. H. Synovial sarcoma, Cancer, v. 19, p. 169, 1966; Moberger G., Nilsson U. Frieberg S. Sino-vial sarcoma, Copenhagen, 1968, bibliogr.; Stephan G. Zur Rontgenologie des malignen Synovialoma, Fortsehr. Rontgenstr., Bd 104, S. 864, 1966; Stout A. P. a. Lattes R. Tumors of the soft tissues, p. 86, Washington, 1967.
V. M. Blinov; V. I. Kvashnina (rents)