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Primary synovial sarcoma of lung.

- Lung India (2014)

Bottom Line: A synovial sarcoma (SS) is a rare form of cancer which usually occurs near the joints of the arm, neck, or leg, but has been documented in most human tissues and organs, including the brain, prostate, and heart.The diagnosis was made on the basis of CT-guided core biopsy and immunohistochemistry.So, the final diagnosis was primary SS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology and Pathology, Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, West Bengal, India.

ABSTRACT
A synovial sarcoma (SS) is a rare form of cancer which usually occurs near the joints of the arm, neck, or leg, but has been documented in most human tissues and organs, including the brain, prostate, and heart. Primary pulmonary SS is an extremely rare tumor. We report a case of primary SS of lung who presented with severe chest pain and a large right lung mass with right-sided pleural effusion in computed tomography (CT) scan of thorax. The diagnosis was made on the basis of CT-guided core biopsy and immunohistochemistry. On immunohistochemistry, tumor cell expressed epithelial membrane antigen, bcl 2, Vimentin and smooth muscle actin and were immunonegative for S100 and cytokeratin. So, the final diagnosis was primary SS.

No MeSH data available.


Related in: MedlinePlus

H/E stained section of the computed tomography guided trucut biopsy (×400) showing spindle cells in fascicles
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Figure 3: H/E stained section of the computed tomography guided trucut biopsy (×400) showing spindle cells in fascicles

Mentions: A case of 53-year-old male patients presented to us on 1st December 2011 with right-sided chest pain, cough, and associated occasional fever. His history was unremarkable. He had no previous surgeries. He was a nonsmoker and nonalcoholic. On examination, patient was healthy male with no abnormality. Chest examination revealed a dull percussion note and decreased breath sounds at right upper lung. Thorough clinical examination of patient did not reveal any abnormality elsewhere in the body. X ray chest showed a large right lung mass with shift of mediastinum to the right and blurring of right costophrenic angle. High-resolution computed tomography (CT) scan of thorax, dated September 2011, revealed a huge right lung space occupying lesion (SOL), right pleural effusion and erosion of 4th rib [Figure 1]. CT guided fine needle aspiration cytology (FNAC) done from right lung SOL revealed spindle cell neoplasm [Figure 2]. Pleural fluid analysis was negative for malignant cells. Further work up for metastasis was negative. He was sent to cardiothoracic surgery for consultation. But in view of huge mass and pleural effusion, it was considered inoperable. To further confirm the diagnosis, he was advised CT-guided trucut biopsy and immunohistochemistry. Histology showed a spindle cell neoplasm with oval to spindle cells, hyperchromatic nuclei and occasional mitosis, suggesting a sarcoma [Figure 3]. Immunohistochemical staining was diffusely positive for Vimentin, strongly positive for bcl 2, patchy positive for EMA, and immunonegative for S-100 and cytokeratin. So, final diagnosis was made as synovial cell sarcoma. He was treated with six cycles of ifosfamideand doxorubicin-based chemotherapy, completed in July 2012. He was then reassessed with contrast-enhanced computed tomography (CECT) thorax and brain. CT chest revealed a huge soft tissue mass (24 × 4 × 15 cm) in right hemithorax with erosion in 4th and 5th rib. CT brain revealed lucent areas in bones of right wall of orbit and occipital bone suggestive of metastasis. After that as per our multidisciplinary board advice, he was advised palliative radiotherapy to right lung mass. Radiotherapy was started with palliative intent with 30 Gy in conventional fractionation using three-dimensional conformal radiotherapy technique in 6 MV Linear accelerator. As patient improved symptomatically, radiotherapy was continued till 50 Gy in conventional fractionation, keeping dose to organs at risk within tolerance limit. After completion of radiotherapy, he was kept on supportive care and follow-up. In January 2013, he came for review. Chest examination showed no breath sounds in right side. CECT thorax revealed neoplastic lesion in right lung (18 × 10 × 11 cm) and moderate pleural effusion. He was advised to do a positron emission tomography (PET) scan. PET scan report dated 06/05/2013 showed a non-fluorodeoxyglucose (FDG) avid large mass lesion with central necrosis in right lung measuring 20 × 11.3 × 9.2 cm. Right lower hemithorax showed a small non-FDG avid pleural effusion. Adjacent pleura showed FDG avid (Standardized uptake value max 3.8) pleural thickening. A centimetric calcified precarinal node with mild FDG avidity (Standardized uptake value max 2.18) and a small non-FDG avid aortopulmonary node are also seen [Figure 4]. Patient is stable till date and is kept on supportive care.


Primary synovial sarcoma of lung.

- Lung India (2014)

H/E stained section of the computed tomography guided trucut biopsy (×400) showing spindle cells in fascicles
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129604&req=5

Figure 3: H/E stained section of the computed tomography guided trucut biopsy (×400) showing spindle cells in fascicles
Mentions: A case of 53-year-old male patients presented to us on 1st December 2011 with right-sided chest pain, cough, and associated occasional fever. His history was unremarkable. He had no previous surgeries. He was a nonsmoker and nonalcoholic. On examination, patient was healthy male with no abnormality. Chest examination revealed a dull percussion note and decreased breath sounds at right upper lung. Thorough clinical examination of patient did not reveal any abnormality elsewhere in the body. X ray chest showed a large right lung mass with shift of mediastinum to the right and blurring of right costophrenic angle. High-resolution computed tomography (CT) scan of thorax, dated September 2011, revealed a huge right lung space occupying lesion (SOL), right pleural effusion and erosion of 4th rib [Figure 1]. CT guided fine needle aspiration cytology (FNAC) done from right lung SOL revealed spindle cell neoplasm [Figure 2]. Pleural fluid analysis was negative for malignant cells. Further work up for metastasis was negative. He was sent to cardiothoracic surgery for consultation. But in view of huge mass and pleural effusion, it was considered inoperable. To further confirm the diagnosis, he was advised CT-guided trucut biopsy and immunohistochemistry. Histology showed a spindle cell neoplasm with oval to spindle cells, hyperchromatic nuclei and occasional mitosis, suggesting a sarcoma [Figure 3]. Immunohistochemical staining was diffusely positive for Vimentin, strongly positive for bcl 2, patchy positive for EMA, and immunonegative for S-100 and cytokeratin. So, final diagnosis was made as synovial cell sarcoma. He was treated with six cycles of ifosfamideand doxorubicin-based chemotherapy, completed in July 2012. He was then reassessed with contrast-enhanced computed tomography (CECT) thorax and brain. CT chest revealed a huge soft tissue mass (24 × 4 × 15 cm) in right hemithorax with erosion in 4th and 5th rib. CT brain revealed lucent areas in bones of right wall of orbit and occipital bone suggestive of metastasis. After that as per our multidisciplinary board advice, he was advised palliative radiotherapy to right lung mass. Radiotherapy was started with palliative intent with 30 Gy in conventional fractionation using three-dimensional conformal radiotherapy technique in 6 MV Linear accelerator. As patient improved symptomatically, radiotherapy was continued till 50 Gy in conventional fractionation, keeping dose to organs at risk within tolerance limit. After completion of radiotherapy, he was kept on supportive care and follow-up. In January 2013, he came for review. Chest examination showed no breath sounds in right side. CECT thorax revealed neoplastic lesion in right lung (18 × 10 × 11 cm) and moderate pleural effusion. He was advised to do a positron emission tomography (PET) scan. PET scan report dated 06/05/2013 showed a non-fluorodeoxyglucose (FDG) avid large mass lesion with central necrosis in right lung measuring 20 × 11.3 × 9.2 cm. Right lower hemithorax showed a small non-FDG avid pleural effusion. Adjacent pleura showed FDG avid (Standardized uptake value max 3.8) pleural thickening. A centimetric calcified precarinal node with mild FDG avidity (Standardized uptake value max 2.18) and a small non-FDG avid aortopulmonary node are also seen [Figure 4]. Patient is stable till date and is kept on supportive care.

Bottom Line: A synovial sarcoma (SS) is a rare form of cancer which usually occurs near the joints of the arm, neck, or leg, but has been documented in most human tissues and organs, including the brain, prostate, and heart.The diagnosis was made on the basis of CT-guided core biopsy and immunohistochemistry.So, the final diagnosis was primary SS.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology and Pathology, Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, West Bengal, India.

ABSTRACT
A synovial sarcoma (SS) is a rare form of cancer which usually occurs near the joints of the arm, neck, or leg, but has been documented in most human tissues and organs, including the brain, prostate, and heart. Primary pulmonary SS is an extremely rare tumor. We report a case of primary SS of lung who presented with severe chest pain and a large right lung mass with right-sided pleural effusion in computed tomography (CT) scan of thorax. The diagnosis was made on the basis of CT-guided core biopsy and immunohistochemistry. On immunohistochemistry, tumor cell expressed epithelial membrane antigen, bcl 2, Vimentin and smooth muscle actin and were immunonegative for S100 and cytokeratin. So, the final diagnosis was primary SS.

No MeSH data available.


Related in: MedlinePlus