Asian Journal of Research in Surgery

Aims: To present a rare case of synovial sarcoma (SS) arising in the foot of a young adult male and highlight the diagnostic challenges, treatment approach, and prognosis associated with this aggressive malignancy.

Presentation of Case: A 23-year-old Caucasian male with a history of polydactyly presented with a progressively painful mass in the third toe of the left foot. MRI revealed a 4 cm multilobulated soft tissue mass encasing the first phalanx. Biopsy with pathological examination confirmed synovial sarcoma, and the patient underwent metatarsal-level amputation with clear margins. Two years postoperatively, the patient experienced a regional relapse in the gluteal area and developed pulmonary metastases. Despite initiation of chemotherapy, the disease rapidly progressed, and the patient died within a month of relapse.

Discussion: Synovial sarcoma is a rare soft tissue sarcoma, typically affecting young adults and often arising in the extremities. It frequently presents with nonspecific symptoms and can mimic benign conditions, delaying diagnosis. MRI is the imaging modality of choice, and definitive diagnosis relies on histopathological analysis. While surgery with negative margins remains the cornerstone of treatment, recurrence and metastasis are common, particularly in larger tumors.

Conclusion: This case illustrates the aggressive nature of synovial sarcoma despite adequate initial management. Clinicians should maintain a high index of suspicion for SS in persistent foot masses, and ongoing research is vital to improve outcomes through better systemic therapies and relapse prevention strategies.