• Jie Liu, Xiajie Huang, Xinyun Liang, Xinhua Xian, Yangzhou Mo, Xiaomei Wu, William Lu, Jian Li, and Yan Chen.
• Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
• Medicine (Baltimore). 2025 Jan 10; 104 (2): e41256e41256.

RationaleSynovial sarcoma (SS) is a rare and highly malignant soft tissue sarcoma. When SS occurs in atypical locations, it can present significant diagnostic challenges. We report a case of paraspinal SS initially misdiagnosed as spinal tuberculosis, highlighting the diagnostic difficulties and the importance of considering SS in the differential diagnosis.Patient ConcernsA 23-year-old woman presented with progressively worsening lower left back pain over 3 weeks, accompanied by weakness and numbness in her left lower limb. She was initially misdiagnosed with spinal tuberculosis at 2 different hospitals based on weakly positive anti-tuberculosis antibodies and imaging findings. Despite ongoing anti-tuberculosis treatment, her condition continued to deteriorate.DiagnosesThe first surgery revealed findings inconsistent with spinal tuberculosis, but a tumor could not be excluded. However, the initial pathological biopsy was inconclusive. A second surgery confirmed the diagnosis of SS through histopathological examination.InterventionsThe patient underwent a second surgery for mass resection and biopsy confirmation. Unfortunately, by the time the correct diagnosis was made, the disease had metastasized to her lungs, and the optimal window for surgical intervention had been missed.OutcomesThe patient's delayed diagnosis resulted in extensive diffuse metastasis to both lungs, significantly impacting her survival.LessonsThis case underscores the need to consider malignancies such as SS in the differential diagnosis of spinal lesions, particularly when clinical response to treatment is poor. Early diagnosis and timely surgical intervention are critical to improving patient outcomes. Our literature review provides further insights into the characteristics of paraspinal SS and strategies to prevent misdiagnosis, emphasizing the importance of early and accurate diagnosis to enhance patient survival.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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