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<p>Hypervascular plantar soft-tissue lesions in children may be misinterpreted as benign vascular abnormalities, particularly when Doppler ultrasound shows marked internal vascularity. We report a 12-year-old boy with a painful plantar foot mass initially considered a hemangioma or low-flow vascular malformation on ultrasound and MRI. Although imaging demonstrated prominent vascularity and enhancement, the lesion was predominantly solid, showed irregular enhancement and partially ill-defined margins, and lacked typical serpiginous morphology or definite flow voids. Image-guided biopsy revealed a malignant spindle-cell neoplasm. Histology showed an infiltrative monophasic spindle-cell tumor involving adjacent soft tissues, and immunohistochemistry demonstrated focal cytokeratin AE1/AE3 expression, multifocal EMA positivity, and strong diffuse nuclear SS18 staining, supporting synovial sarcoma. The patient underwent limb-sparing resection after multidisciplinary evaluation. This case emphasizes the importance of pathologic confirmation before vascular-directed intervention.</p>

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Plantar synovial sarcoma mimicking a vascular malformation in a child: a clinicopathologic case report

  • 期刊论文

  • 发表日期：

    2026年6月25日

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  • Isabella Andrea Bolaños Bermúdez,
  • María José Gutiérrez Sierra,
  • Laura Nataly Panqueva Giraldo,
  • David Fernando Torres Cortés,
  • Oscar Mauricio Rivero Rapalino,
  • Pablo Arbeláez Echeverri,
  • Mauricio Alfonso Palau Lázaro

摘要

Hypervascular plantar soft-tissue lesions in children may be misinterpreted as benign vascular abnormalities, particularly when Doppler ultrasound shows marked internal vascularity. We report a 12-year-old boy with a painful plantar foot mass initially considered a hemangioma or low-flow vascular malformation on ultrasound and MRI. Although imaging demonstrated prominent vascularity and enhancement, the lesion was predominantly solid, showed irregular enhancement and partially ill-defined margins, and lacked typical serpiginous morphology or definite flow voids. Image-guided biopsy revealed a malignant spindle-cell neoplasm. Histology showed an infiltrative monophasic spindle-cell tumor involving adjacent soft tissues, and immunohistochemistry demonstrated focal cytokeratin AE1/AE3 expression, multifocal EMA positivity, and strong diffuse nuclear SS18 staining, supporting synovial sarcoma. The patient underwent limb-sparing resection after multidisciplinary evaluation. This case emphasizes the importance of pathologic confirmation before vascular-directed intervention.