What’s the prognosis for a young adult (20 years-old) with synovial sarcoma of the big toe?



The name synovial sarcoma is a bit misleading since microscopic studies of the cells from these tumors show clear differences from true synovial cells. And the name would lead you to believe the tumors occur inside a synovial joint, when in fact, that is not the case. The tumors are close to joints and the cells resemble synovial tissue but that’s as far as the similarities go.

However, the term “sarcoma” does mean soft tissue malignancy and synovial sarcomas are malignant. Malignancy means they can spread to other tissues in the body causing disfigurement and even death.

In the case of synovial sarcoma, small tumors (less than five centimeters), in young people (less than 25 years old), and detected early can have a very good outcome with appropriate treatment (surgery to remove the mass). Wide margins (cutting around the tumor with normal tissue bordering the entire mass) must be obtained.

A delayed diagnosis with inappropriate treatment (e.g., in the case of misdiagnosis) has a less positive prognosis with an increased potential for cancer recurrence. Death occurs in as many as 40 per cent of the patients diagnosed with this condition after it has reached a larger size (five centimeters or more).

There have only been 25 or 26 reported cases of synovial sarcoma in the forefoot (including the big toe) so we do not have a large data group to rely on for these statistics. This malignancy occurs most often in young adults who are healthy and perhaps better able to respond well to treatment.