Tension Pneumothorax: Is it Sarcoma or Pazopanib?

Abstract

Synovial sarcomas are rare malignant tumors that originate from primitive pluripotent mesenchymal stem cells that look similar to the developing synovium, but are histologically unrelated to it. Sarcomas commonly metastasize to the lungs and surrounding pleura, with a documented incidence as high as 85% for pleural-based metastases. The incidence of spontaneous pneumothorax in patients with sarcomas is only 1.9%, with synovial sarcoma being the third most common type of sarcoma associated with pneumothorax. While surgical resection is usually the treatment for localized primary synovial cell sarcoma, metastatic disease requires systemic therapy, mainly chemotherapy. Failure of chemotherapy calls for the use of targeted therapeutic agents such as pazopanib. Pazopanib has been linked to the incidence of spontaneous pneumothorax in previous case studies. However, primary research fails to establish a statistically significant causal association. Research shows that pneumothorax can result from lung metastases independent of therapeutic side effects. We report a case of synovial sarcoma of trapezius origin with secondary lung metastases, and development of pneumothorax after pazopanib treatment. We discuss the incidence of pneumothorax as a medication side effect versus independent effect of natural disease progression, and how this plays role in deciding when to continue using a medication in the face of complications.

Whole‐exome sequencing in primary pulmonary synovial sarcoma misdiagnosed as mesothelioma: A case report and literature review

“…It has been approved in Japan for treating soft‐tissue sarcoma and kidney cancer 50 . However, prazopanib can cause tumor necrosis and induce pneumonia or tension pneumothorax, exacerbating disease progression 11,51 . Until now, it has been reported that apatinib is effective for treating primary synovial sarcoma of the lung 48 and patients with advanced sarcoma 52 .…”

“…50 However, prazopanib can cause tumor necrosis and induce pneumonia or tension pneumothorax, exacerbating disease progression. 11,51 Until now, it has been reported that apatinib is effective for treating primary synovial sarcoma of the lung 48 and patients with advanced sarcoma. 52 Anlotinib, a receptor tyrosine kinase inhibitor, has both antitumor and antiangiogenic activities for advanced lung cancer, and combined with immunotherapy, its curative effect will be better.…”