Synovial sarcoma is a relatively rare malignancy, accounting for 5–10 % of all soft tissue sarcomas, with approximately 1000 new cases diagnosed annually in the United States [1]. Although its name suggests an origin from the synovium, the molecular and cellular origin of synovial sarcoma remains elusive, and its occurrence within the joint space is infrequent [2]. Synovial sarcoma predominantly arises from the deep tissues of the extremities but has also been identified within visceral organs [3]. Given its diverse clinical manifestations, ranging from palpable masses to symptoms such as bursitis and arthritis [4], timely and accurate diagnosis is essential to prevent progression and potential metastasis, which are associated with significantly worse survival outcomes [4,5].

The landscape of synovial sarcoma diagnosis and treatment is riddled with challenges and ambiguities. Although surgical resection and radiation therapy are the cornerstone treatments for synovial sarcoma [6], the efficacy of systemic chemotherapy, especially for advanced stages, remains a subject of ongoing debate [7]. Moreover, the clinical manifestations of synovial sarcoma are diverse, and its predilection for younger populations further complicates timely diagnosis [5]. Visceral synovial sarcoma, in particular, is a significant enigma. Its infrequent incidence, coupled with its tendency to emerge in unconventional anatomical sites, often poses significant diagnostic and management challenges. While advancements have been made with the identification of hallmark genetic markers, such as the t(X:18) translocation and SS18:SSX fusion protein [5,8,9], a comprehensive understanding, particularly of visceral synovial sarcoma, remains limited to case reports and case series in the current literature [[10], [11], [12], [13], [14]].

This study aims to address this gap by offering a comparative analysis of the demographic, clinical, and pathological characteristics of visceral synovial sarcoma and soft tissue synovial sarcoma. Furthermore, it aims to shed light on treatment variations and prognostic outcomes, thereby providing a more holistic understanding of synovial sarcoma and guiding future therapeutic strategies.