title: Synovial sarcoma--unusual presentation with cerebral hemorrhage.
abstract: BACKGROUND
  Soft-tissue sarcomas account for 1% of all malignancies in adults. Typical symptoms comprise a growing and painless mass. Occasionally, the diagnosis is facilitated by secondaries.
  
  
  METHODS
  Here we report the first case presented with intracranial hemorrhage caused by a metastasis of a previously unknown synovial sarcoma. The 74-year-old female patient was under anticoagulation for recurrent thrombosis of the right popliteal vein due to compression by the sarcoma, misdiagnosed as Baker's cyst. The brain metastasis was resected, and after an incisional biopsy of the suspected tumor, which confirmed the diagnosis of a synovial sarcoma, an above knee amputation was performed because of the invasion of the neurovascular structures in the popliteal fossa.
  
  
  RESULTS
  The patient died 11 months after the initial event from pulmonary and further brain metastases.
  
  
  CONCLUSIONS
  Brain metastases are seldom the primary factor in the management of advanced synovial sarcoma. Initially, the primary tumor was thought to be a benign cyst; we therefore recommend a biopsy/excision of lesions greater than 5 cm in size and with growth tendency to allow appropriate treatment.
authors.affiliation: Department of Surgery, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. przkora@yahoo.com
authors.forename: Rene
authors.initials: R
authors.lastname: Przkora
authors.forename: Peter
authors.initials: P
authors.lastname: Vogel
authors.forename: Odo W
authors.initials: OW
authors.lastname: Ullrich
authors.forename: Ruth
authors.initials: R
authors.lastname: Knüchel
authors.forename: Karl W
authors.initials: KW
authors.lastname: Jauch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bolder
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000473:pathology