Primary Pulmonary Synovial Sarcoma

Abstract

Primary sarcoma of the lung and/or pleural cavity is a rare finding accounting for <0.5% of all thoracic malignancies. Histologically, mesothelioma predominates in this subcategory of neoplasms; its relationship to asbestos exposure and cigarette smoking is well documented. Other tumor types include fibrosarcoma, malignant fibrous histiocytoma, angiosarcoma, leiomyosarcoma, synovial sarcoma, and Ewing sarcoma. Standard evaluation with bronchoscopy and radiographically guided biopsy are frequently nondiagnostic and require open biopsy to provide an adequate tissue sample. Keywords pleural images, pleural malignancy Case StudyA 39-year-old man employed as a housepainter presented with fevers, weight loss, and a nonproductive cough. He reported having a positive tuberculin skin test and received Bacillus Calmette-Guérin vaccine as a youth. Current sputum cultures and cytology were negative for malignancy. Computed tomography of the chest showed a large right pleural effusion and 3 pleural-based nodules (Figure 1). Bronchoscopy demonstrated no endobronchial lesions and a negative aspirate cytology. Thoracentesis and pleural biopsy yielded only pleural fibrosis.Thoracoscopic exploration of the chest revealed a longitudinally spreading, thick, friable tumor mass along the parietal pleural surface of the lung. Light microscopy showed a high-grade spindle cell neoplasm (Figure 2;

Primary Pleuropulmonary Synovial Sarcoma: A Case

“…There has been no large series documenting the exact number of repeated pleuropulmonary synovial sarcoma cases worldwide. Ipsilateral pleural effusion was reported, while mediastinal lymphadenopathy was rare [7]. Our patient presented pulmonary and pleural localization at the same time; the presence of an endobronchial bud at bronchial fibroscopy is more in favor of a pulmonary primitive; otherwise double simultaneous localization at the same density at thoracic CT makes it difficult to decide.…”

Primary Pulmonary Synovial Sarcoma in a 49-Year-Old Male

“…The tumor tends to be large and, at times, can cause a partial or complete opacification of the lungs. Pleural effusion, cavitation, calcification, and lymphadenopathy are typically absent in patients with primary synovial sarcoma [ 5 , 6 ]. Most tumors are larger than 7 cm, causing compression of the surrounding tissue and making the site of origin difficult to discern.…”