Document Detail

Variability in the presentation of synovial sarcoma in children: a plea for greater awareness.
MedLine Citation:
PMID:  18669969     Owner:  NLM     Status:  MEDLINE    
We have analysed the pattern of symptoms in patients presenting with synovial sarcoma to identify factors which led to long delays in diagnosis. In 35 children, the early symptoms and the results of clinical and radiological investigation were reviewed, along with the presumed diagnoses. The duration of symptoms was separated into patient delay and doctor delay. Only half of the patients had one or more of the four clinical findings suggestive of sarcoma according to the guidance of the National Institute for Clinical Excellence at the onset of symptoms. Of the 33 children for whom data were available, 16 (48.5%) presented with a painless mass and in ten (30.3%) no mass was identified. Seven (21.2%) had an unexplained joint contracture. Many had been extensively investigated unsuccessfully. The mean duration of symptoms was 98 weeks (2 to 364), the mean patient delay was 43 weeks (0 to 156) and the mean doctor delay was 50 weeks (0 to 362). The mean number of doctors seen before referral was three (1 to 6) and for 15 patients the diagnosis was obtained after unplanned excision. Tumours around the knee and elbow were associated with a longer duration of symptoms and longer doctor delay compared with those at other sites. Delays did not improve significantly over the period of our study of 21 years, and we were unable to show that delay in diagnosis led to a worse prognosis. Our findings highlight the variety of symptoms associated with synovial sarcoma and encourage greater awareness of this tumour as a potential diagnosis in childhood.
F Chotel; A Unnithan; C R Chandrasekar; R Parot; L Jeys; R J Grimer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  90     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-01     Completed Date:  2008-10-28     Revised Date:  2010-11-10    
Medline Journal Info:
Nlm Unique ID:  0375355     Medline TA:  J Bone Joint Surg Br     Country:  England    
Other Details:
Languages:  eng     Pagination:  1090-6     Citation Subset:  AIM; IM    
Service Orthopédie, Hôpital, Universitaire Mère Enfant de Lyon, 59 Boulevard Pinel, 69677, Bron cedex, France.
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MeSH Terms
Child, Preschool
Diagnosis, Differential
Elbow / pathology*,  radiography
Joint Diseases / pathology*,  radiography
Knee Joint / pathology*,  radiography
Magnetic Resonance Imaging
Rare Diseases
Sarcoma, Synovial / pathology*
Statistics as Topic
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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