Groin synovial sarcoma with intraluminal femoral sheath involvement

Synovial sarcomas are highly aggressive soft tissue malignant tumors that occur primarily in young adults. They arise from mesenchymal tissue and typically in or near tendons and tendon sheaths. They can develop at any site but the majority (80-95%) of synovial sarcomas are located in the extremities and mostly at the lower extremities. Groin synovial sarcoma is rare. About 10% of lower limb soft tissue sarcomas have major vessel involvement. In the past, amputation was the standard surgical procedure for lower limb soft tissue sarcoma with major vessels involvement. However, using modern surgical techniques, we can successfully perform a limb-preserving operation with a tumor-free margin. A 17-year-old girl presented with left inguinal synovial sarcoma with femoral artery and vein encasement. The patient received radical tumor resection with major vascular structures. Segmental femoral vessel defects were reconstructed with polytetrafluoroethylene grafts. After revascularization, we designed a pedicled anterolateral thigh fasciocutaneous flap for coverage of the wound and reconstructed vessels simultaneously. The circulation of the lower extremity was good and the girl recovered well after the surgery without morbidity. Synovial sarcoma would potentially be associated with local recurrence and distant metastasis. The presences of bone and neurovascular bundle invasion are adverse predictors of recurrence and mortality. Surgery remains the mainstay of treatment. In the advance of current surgical technique, limb-preserving surgery is possible even for tumor-involved major vessels.