{"id":"https://openalex.org/W7225568947","doi":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","title":"Synovial Sarcoma of the Tibial Nerve in the Distal Leg: A Case of Diagnostic Ambiguity and Multimodal Management Protocol for Limb Salvage and Nerve Reconstruction \u2013 A Case Report","display_name":"Synovial Sarcoma of the Tibial Nerve in the Distal Leg: A Case of Diagnostic Ambiguity and Multimodal Management Protocol for Limb Salvage and Nerve Reconstruction \u2013 A Case Report","publication_year":2026,"publication_date":"2026-01-01","ids":{"openalex":"https://openalex.org/W7225568947","doi":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","pmid":"https://pubmed.ncbi.nlm.nih.gov/42997041","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13740898"},"language":"en","primary_location":{"id":"doi:10.13107/jocr.2026.v16.i11.8374","doi":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","is_oa":true,"landing_page_url":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","pdf_url":null,"source":{"id":"https://openalex.org/S2764394085","display_name":"Journal of Orthopaedic Case Reports","issn_l":"2250-0685","issn":["2250-0685","2321-3817"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310318662","host_organization_name":"Indian Orthopaedic Research Group","host_organization_lineage":["https://openalex.org/P4310318662"],"host_organization_lineage_names":["Indian Orthopaedic Research Group"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Case Reports","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5148804464","display_name":"Varun R Mehta","orcid":"https://orcid.org/0009-0001-8647-2273","observed_orcids":["https://orcid.org/0009-0001-8647-2273"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Varun R Mehta","raw_affiliation_strings":["Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5009691495","display_name":"Rajkumar Mehta","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Rajkumar Mehta","raw_affiliation_strings":["Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5110754069","display_name":"Rahul Parmar","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Rahul Parmar","raw_affiliation_strings":["Department of Orthopedics, V Care Hospital, Surat, Gujarat, India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, V Care Hospital, Surat, Gujarat, India","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5150326338","display_name":"Sonal R Mehta","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Sonal R Mehta","raw_affiliation_strings":["Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, Mehta Hospital, Ankleshwar, Gujarat, India","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5148804464"],"corresponding_institution_ids":[],"apc_list":{"value":250,"currency":"USD","value_usd":250},"apc_paid":{"value":250,"currency":"USD","value_usd":250},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.83645048,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"16","issue":"11","first_page":"20","last_page":"26"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10253","display_name":"Sarcoma Diagnosis and Treatment","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10253","display_name":"Sarcoma Diagnosis and Treatment","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11173","display_name":"Neurofibromatosis and Schwannoma Cases","score":0.0006000000284984708,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11638","display_name":"Cardiac tumors and thrombi","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9876000285148621},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.6333000063896179},{"id":"https://openalex.org/C2776825438","wikidata":"https://www.wikidata.org/wiki/Q1978198","display_name":"Tibial nerve","level":3,"score":0.6080999970436096},{"id":"https://openalex.org/C105572291","wikidata":"https://www.wikidata.org/wiki/Q7002775","display_name":"Neurovascular bundle","level":2,"score":0.5192000269889832},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.4661000072956085},{"id":"https://openalex.org/C2778256501","wikidata":"https://www.wikidata.org/wiki/Q223911","display_name":"Sarcoma","level":2,"score":0.42739999294281006},{"id":"https://openalex.org/C143409427","wikidata":"https://www.wikidata.org/wiki/Q161238","display_name":"Magnetic resonance imaging","level":2,"score":0.40130001306533813},{"id":"https://openalex.org/C2776910622","wikidata":"https://www.wikidata.org/wiki/Q2619315","display_name":"Synovial sarcoma","level":3,"score":0.3935000002384186},{"id":"https://openalex.org/C2777330947","wikidata":"https://www.wikidata.org/wiki/Q663799","display_name":"Popliteal fossa","level":2,"score":0.39149999618530273},{"id":"https://openalex.org/C4441509","wikidata":"https://www.wikidata.org/wiki/Q6418787","display_name":"Multimodal therapy","level":2,"score":0.3343999981880188},{"id":"https://openalex.org/C2777522714","wikidata":"https://www.wikidata.org/wiki/Q707659","display_name":"Posterior tibial artery","level":3,"score":0.3303000032901764},{"id":"https://openalex.org/C2780923182","wikidata":"https://www.wikidata.org/wiki/Q6135922","display_name":"Sural nerve","level":2,"score":0.3294999897480011},{"id":"https://openalex.org/C2777982462","wikidata":"https://www.wikidata.org/wiki/Q2481887","display_name":"Adjuvant therapy","level":3,"score":0.32659998536109924},{"id":"https://openalex.org/C2778629024","wikidata":"https://www.wikidata.org/wiki/Q720020","display_name":"Soft tissue sarcoma","level":3,"score":0.32100000977516174},{"id":"https://openalex.org/C106207104","wikidata":"https://www.wikidata.org/wiki/Q324926","display_name":"Fibula","level":3,"score":0.3116999864578247},{"id":"https://openalex.org/C2779399171","wikidata":"https://www.wikidata.org/wiki/Q1483951","display_name":"Malignancy","level":2,"score":0.3107999861240387},{"id":"https://openalex.org/C2781447767","wikidata":"https://www.wikidata.org/wiki/Q369148","display_name":"Schwannoma","level":2,"score":0.3021000027656555},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.28999999165534973},{"id":"https://openalex.org/C2778990603","wikidata":"https://www.wikidata.org/wiki/Q6482011","display_name":"Laminotomy","level":4,"score":0.28850001096725464},{"id":"https://openalex.org/C2781437307","wikidata":"https://www.wikidata.org/wiki/Q977628","display_name":"Microsurgery","level":2,"score":0.2800999879837036},{"id":"https://openalex.org/C2780775027","wikidata":"https://www.wikidata.org/wiki/Q17141389","display_name":"Salvage therapy","level":3,"score":0.2800000011920929},{"id":"https://openalex.org/C2775934546","wikidata":"https://www.wikidata.org/wiki/Q179991","display_name":"Biopsy","level":2,"score":0.2637999951839447}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.13107/jocr.2026.v16.i11.8374","doi":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","is_oa":true,"landing_page_url":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","pdf_url":null,"source":{"id":"https://openalex.org/S2764394085","display_name":"Journal of Orthopaedic Case Reports","issn_l":"2250-0685","issn":["2250-0685","2321-3817"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310318662","host_organization_name":"Indian Orthopaedic Research Group","host_organization_lineage":["https://openalex.org/P4310318662"],"host_organization_lineage_names":["Indian Orthopaedic Research Group"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Case Reports","raw_type":"journal-article"},{"id":"pmid:42997041","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42997041","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of orthopaedic case reports","raw_type":"Case Reports"},{"id":"pmh:oai:pubmedcentral.nih.gov:13740898","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13740898/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"J Orthop Case Rep","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.13107/jocr.2026.v16.i11.8374","doi":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","is_oa":true,"landing_page_url":"https://doi.org/10.13107/jocr.2026.v16.i11.8374","pdf_url":null,"source":{"id":"https://openalex.org/S2764394085","display_name":"Journal of Orthopaedic Case Reports","issn_l":"2250-0685","issn":["2250-0685","2321-3817"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310318662","host_organization_name":"Indian Orthopaedic Research Group","host_organization_lineage":["https://openalex.org/P4310318662"],"host_organization_lineage_names":["Indian Orthopaedic Research Group"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Case Reports","raw_type":"journal-article"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":1,"referenced_works":["https://openalex.org/W3158011165"],"related_works":[],"abstract_inverted_index":{"Introduction:":[0],"Synovial":[1],"sarcoma":[2,260],"(SS)":[3],"is":[4,32,194,261,315,318,321],"a":[5,37,133,241,339,378],"rare,":[6],"aggressive":[7],"malignancy":[8],"accounting":[9],"for":[10,65,237,344,382],"approximately":[11],"7%":[12],"of":[13,28,39,98,145,168,181,217,220,251,269,292,309,342,347,373],"all":[14,331],"soft-tissue":[15,239,259,333],"sarcomas;":[16],"its":[17],"occurrence":[18],"in":[19,56,69,101,132,148,256,299,307,385],"the":[20,25,29,44,57,62,102,117,152,166,182,197,226,246,266,273,282,287,300,368,374],"peripheral":[21],"nervous":[22],"system,":[23],"particularly":[24],"tibial":[26,45,118,183,301],"nerve":[27,184,202,356],"distal":[30],"leg,":[31],"exceptionally":[33],"uncommon.":[34],"We":[35],"present":[36],"case":[38,60,328],"primary":[40],"SS":[41,144],"arising":[42],"from":[43],"nerve.":[46,119],"To":[47],"date,":[48],"only":[49],"four":[50],"such":[51],"cases":[52],"have":[53],"been":[54],"reported":[55,87],"literature.":[58],"This":[59,327],"underscores":[61],"critical":[63],"need":[64],"prompt,":[66],"accurate":[67],"diagnosis":[68],"atypical":[70],"anatomical":[71],"locations":[72],"to":[73,106,212,264],"optimize":[74],"oncological":[75],"outcomes":[76],"and":[77,131,150,185,235,254,284,358,366],"preserve":[78],"functional":[79],"extremity.":[80],"Case":[81],"Report:":[82],"A":[83,349],"17-year-old":[84],"male":[85],"patient":[86,288],"first":[88],"time":[89],"on":[90,165],"date":[91],"July":[92],"09,":[93],"2024,":[94],"with":[95,108,191,225,232,295,338],"presenting":[96],"complaints":[97],"acute":[99],"pain":[100],"left":[103],"calf":[104],"radiating":[105],"sole-foot":[107],"palpable":[109],"mass":[110],"(3":[111],"cm":[112,147],"\u00d7":[113],"1":[114],"cm)":[115],"along":[116],"Initially,":[120],"it":[121,138],"was":[122,139,159,187,205,210,277,289],"misdiagnosed":[123],"as":[124,142,161],"schwannoma":[125],"by":[126],"ultrasound,":[127],"magnetic":[128],"resonance":[129],"imaging":[130],"ultrasonography":[134],"guided":[135],"biopsy.":[136],"However,":[137],"finally":[140],"diagnosed":[141],"monophasic":[143],"<3":[146],"size":[149],"intra-compartment,":[151],"characteristic":[153],"SS18-SSX":[154],"gene":[155],"fusion.":[156],"The":[157,371],"tumor":[158,375],"classified":[160],"Grade":[162],"2":[163],"(Intermediate)":[164],"basis":[167],"F\u00e9d\u00e9ration":[169],"Nationale":[170],"des":[171],"Centres":[172],"de":[173],"Lutte":[174],"Center":[175],"le":[176],"Cancer.":[177],"Wide":[178],"marginal":[179],"excision":[180],"scar":[186],"done.":[188],"Complete":[189],"resection":[190],"R0":[192],"margins":[193],"achieved.":[195],"From":[196],"opposite":[198],"limb,":[199],"harvested":[200],"sural":[201],"cable":[203],"grafting":[204],"performed.":[206],"Neurovascular":[207],"local":[208,364],"flap":[209],"used":[211],"cover.":[213],"Adjuvant":[214],"therapy":[215],"consisted":[216],"32":[218],"sessions":[219],"post-operative":[221],"radiation.":[222],"In":[223],"accordance":[224],"EORTC":[227],"62931":[228],"trial":[229],"(\"Adjuvant":[230],"chemotherapy":[231,276],"doxorubicin,":[233],"ifosfamide,":[234],"lenograstim":[236],"resected":[238],"sarcoma:":[240],"multicenter":[242],"randomised":[243],"controlled":[244],"trial\"),":[245],"absolute":[247],"overall":[248],"survival":[249],"benefit":[250],"adjuvant":[252,274,359],"anthracycline":[253],"ifosfamide":[255],"localized":[257],"resectable":[258],"not":[262],"sufficient":[263],"outweigh":[265],"substantial":[267],"risks":[268],"treatment-related":[270],"morbidity,":[271],"Hence,":[272],"anthracycline/ifosfamide-based":[275],"intentionally":[278],"skipped":[279],"(35).":[280],"At":[281],"2-year":[283],"4-month":[285],"follow-up,":[286],"pain-free,":[290],"clear":[291],"cancer":[293],"recurrence,":[294],"mild":[296],"sensory":[297],"blunting":[298],"dermatome,":[302],"suboptimal":[303],"motor":[304],"recovery,":[305],"resulting":[306],"clawing":[308],"toes.":[310],"Musculoskeletal":[311],"Tumor":[312],"Society":[313],"Score":[314],"22/30":[316],"which":[317,320],"considered":[319,322],"\"Good\"":[323],"Functional":[324],"Result.":[325],"Conclusion:":[326],"stresses":[329],"that":[330],"deep-seated":[332],"masses":[334],"must":[335],"be":[336],"treated":[337],"high":[340],"index":[341],"suspicion":[343],"malignancy,":[345],"regardless":[346],"size.":[348],"multimodal":[350],"strategy":[351],"-":[352,361],"combining":[353],"radical":[354],"excision,":[355],"reconstruction,":[357],"radiotherapy":[360],"achieved":[362],"successful":[363],"control":[365],"preserved":[367],"patient's":[369],"limb.":[370],"heterogeneity":[372],"can":[376],"pose":[377],"diagnostic":[379],"challenge,":[380],"even":[381],"pathologists":[383],"specializing":[384],"sarcoma.":[386]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-11-09T00:00:00"}
