Synovial sarcoma is a soft tissue malignancy that generally arises adjacent to joint capsules. The development of this entity in the abdomen is an uncommon presentation. We present a case of a 38-year old male who presented to the emergency room with anemia and abdominal pain. The patient was found to have hemoperitoneum, and on imaging the patient was also noted to have nodular lesions of the abdominal wall and diaphragm. Histopathological analysis of these lesions revealed malignancy. An

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... sive immunohistochemical and genetic analysis was performed to classify the lesion, and it was diagnosed as primary intra-abdominal synovial sarcoma. We explore the intricacies of making this critical diagnosis and review the literature of primary intra-abdominal synovial sarcoma.