title: Dumbbell synovial sarcoma of the thoracolumbar spine: a case report.
abstract: METHODS
  A case report is of a giant dumbbell-shaped synovial sarcoma of the thoracolumbar spine is presented.
  
  
  OBJECTIVE
  To report a case of a rare dumbbell-shaped tumor treated by multimodal approach. Surgical procedures, adjuvant treatment, and outcome were discussed.
  
  
  BACKGROUND
  Synovial sarcomas of the spine are very rare tumors. Radical surgical resection is the goal, but is often not feasible. Dumbbell-shaped spinal synovial sarcoma with a giant extraspinal extension has not yet been reported. The rationale for 2-step surgical procedure and adjuvant therapy is discussed in light of the clinical picture, preoperative imaging and extension of the disease.
  
  
  METHODS
  A 32-year-old male patient presented with signs of quickly progressive paraparesis. A dumbbell-shaped tumor at the level Th12-L1 was found with a giant retroperitoneal extension. Tumor was nonradically excised in a 2-step operation: first through a dorsal approach with laminectomy and removal of the intraspinal extradural part, and later through a laparotomy with removal of the retroperitoneal part. Histologic examination revealed highly malignant synovial sarcoma. Patient was treated with chemotherapy and radiotherapy after surgery.
  
  
  RESULTS
  Patient was in remission and symptom free for 1 year after surgery; he then developed a local recurrence and died soon afterwards.
  
  
  CONCLUSIONS
  A good treatment result was achieved initially. A combined approach in cases like this is warranted, with as radical surgery as possible in order to avoid local recurrence, a common cause of treatment failure in sarcomas.
authors.affiliation: Department of Neurosurgery, University Medical Centre Maribor, Maribor, Slovenia. jravnik@planet.si
authors.forename: Janez
authors.initials: J
authors.lastname: Ravnik
authors.forename: Stojan
authors.initials: S
authors.lastname: Potrc
authors.forename: Rajko
authors.initials: R
authors.lastname: Kavalar
authors.forename: Maja
authors.initials: M
authors.lastname: Ravnik
authors.forename: Branko
authors.initials: B
authors.lastname: Zakotnik
authors.forename: Goraz
authors.initials: G
authors.lastname: Bunc
mesh_terms: D000328:Adult; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007796:Laminectomy; D007813:Laparotomy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D020335:Paraparesis / Q000209:etiology; D012186:Retroperitoneal Neoplasms / Q000556:secondary* / Q000601:surgery; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013584:Sarcoma, Synovial / Q000556:secondary* / Q000601:surgery; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome