A Rare Case of Synovial Sarcoma with Bone Metastasis Mimicking Multiple Myeloma – Challenges of Management in a Nigerian Resource Constrained Setting

Abstract

Background: Synovial sarcoma (SS), a rare carcinoma of soft tissues (including ligaments and muscles) around the big joints of the body, poses significant diagnostic and management challenges in low and middle income countries especially if it presented when metastasis had occurred. When there is metastasis to the bones, it mimics multiple myeloma on radiological skeletal survey. The objective of this report is to draw attention to this rare carcinoma which, usually, presents as a small painless nodule within the first three decades of life. We report this rare case of SS in a middle aged Nigerian lady who presented initially at National Orthopaedic Hospital (NOHE) with chronic severe right hip pain in which the initial radiological skeletal survey strongly suggested multiple myeloma. Definitive diagnosis and management of this case of synovial sarcoma was very challenging to the patient and managing unit. Conclusion: Early diagnosis of SS is critical at which point surgical excision or radiotherapy may be the preferred treatment option to achieve a favorable outcome. When metastasis is extensive, chemotherapy becomes the therapy of choice and it does not come cheap or easily available.