Unusual presentation of poorly differentiated primary pulmonary synovial sarcoma (PD‐PPSS) diagnosed by EBUS‐TBNA with cytogenetic confirmation—A diagnostic challenge

Abstract

Poorly differentiated primary pulmonary synovial sarcoma (PD-PPSS) is a rare, aggressive neoplasm, which occurs in 0.5% cases of all lung malignancies. The diagnosis of PD-PPSS can be very challenging on cytology samples. We present here an unusual case of PD-PPSS diagnosed by 1 While SS accounts for 5%-10% of all softtissue sarcomas, it is rare to originate in the lung; pulmonary sarcomas, overall, comprise <0.5% of primary lung malignancies. 2 SS in older people is more likely to occur at unusual sites such as mediastinum, retroperitoneum, lung, and other viscera. | Case reportA 70-year-old African American, smoker male was recently diagnosed with DLBCL on an abdominal mass by EUS-FNA. During the lymphoma work-up and staging, his CT/PET scan showed left lower lobe lung, hypermetabolic mass measuring 2.4 3 2.3 3 3.2 cm. The clinical consideration of lung mass was most likely metastasis from his known lymphoma (DLBCL) versus primary bronchogenic carcinoma. A bronchoscopy was performed with bronchial brushing and EBUS-TBNA of the mass. Lymph nodes at station 7 were also sampled through EBUS-TBNA.

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

“…The expression of TTF-1, S-100, calmodulin (CAM), CD34, desmin, AE1/AE3, EMA, lung cancer markers (TTF-1 and napsin A), myogenin, neuroendocrine markers (synaptophysin and pheochromogranin A), smooth muscle actin (SMA), signal transduction and transcription activator negative 6 (STAT6), Sox10, calretinin, tumor markers (CD3, CD20, and CD45), synaptophysin, pheochromogranin, P40, FLI-1, Melan A, WT-1, P63, NSE, CDX-2 and vascular tumor markers (TEMS), PD-1 (programmed cell death protein 1), PD-L1(programmed death ligand 1), E-cadherin, β-catenin, and p53 was almost negative, and the proliferation index of Ki-67 in tumor cells exceeded 90%. 5,11,[32][33][34][35][36][37][38] Its cytogenetic marker is T (X; 18) (p11; Q11) chromosomal translocation. 23 The SYT-SSX fusion gene can be detected by reverse transcriptase polymerase chain reaction (RT-PCR) or fluorescence in situ hybridization (FISH).…”