Synovial Sarcoma of Cervical Spinal Nerves

• 32 years-old female presented with progressive symptoms of weakness in the right arm and swelling at the back of the neck. A neurological examination revealed motor and sensory weakness in the right arm.

• Non-contrast CT of the cervical spine

-Coronal (A,B: bone and soft tissue  windows)

-Axial (C: Bone window).

–Widening of intervertebral neural foramina of the right C7 and D1 vertebrae by abnormal soft tissue density lesion that shows no matrix calcifications or bony erosion.

White arrow: Soft tissue density lesion

Red arrow: para-spinal component

Black arrow: intra-spinal epidural component

• Post-contrast MRI of the cervical spine

-Coronal (D, E) and Axial (F) post-contrast T1WI

-Right extensive para-spinal and intra-spinal epidural lobulated mass with heterogeneous signal at TI&T2WIs [not shown] as well as cystic degeneration & hemorrhagic components, where at the post-contrast study it shows intense heterogeneous enhancement

• Synovial sarcoma of the spine is a rare mesenchymal malignant neoplasm.
• It should be considered as one of the differential diagnoses of paraspinal masses.
• Close follow-up by MRI of patients with malignant peripheral nerve sheath tumours special synovial sarcoma is very important to catch local recurrence which is of high rate. The recurrence is more aggressive than the initial disease