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Figure 1. Fifty-six-year-old female with a diagnosis of synovial sarcoma in the right thigh underwent wide local excision 2 years prior to our consultation in an outside institution. She came to our clinic with right shoulder pain. Imaging studies showed an aggressive intramedullary lesion in the right proximal humerus with (A) T1-weighted hypointense, (B) STIR heterogeneous hyperintense, and (C) post-contrast heterogeneous enhancement. This lesion was biopsied and metastatic synovial sarcoma was diagnosed. Staging studies were done and a (D) solitary lung lesion was found suspicious for metastatic disease. The decision was made to start systemic therapy receiving two cycles, but (E) due to the growth of the lung lesion, the decision was made to proceed with (F) wide local excision of the right proximal humerus with reconstruction (reverse total shoulder replacement) and resection of the solitary lung lesion. The patient is 4 years out of surgery and is disease free.