Spontaneous Regression of Primary Pulmonary Synovial Sarcoma

The Role of Surgery for Primary Pulmonary Synovial Sarcoma: A Population-Based Study

INTRODUCTION

The rarity of primary pulmonary synovial sarcoma (PPSS) and the lack of prospective clinical trials resulted in poorly understood treatment modality and clinical outcomes. This study aimed to better understand PPSS based on patients from the Surveillance, Epidemiology, and End Results database.

MATERIALS AND METHODS

Clinical and survival data of PPSS patients who were diagnosed during 1989 through 2016 and retrieved from the Surveillance, Epidemiology, and End Results database were studied. Kaplan-Meier analyses and Cox proportional hazards model were applied to evaluate the overall survival (OS) and disease-specific survival (DSS) of PPSS patients.

RESULTS

A total of 122 patients with PPSS were included (median age: 50 y). PPSS accounted for 4.5% (122/2741) of total primary synovial sarcoma. Most of the patients were diagnosed as poor or undifferentiated grade (52.0% and 34.0%). Cancer-directed surgery was performed for 74.4% of PPSS patients and 28.2% of patients received radiotherapy. The 1-year, 3-year, 5-year, and 10-year OS rates of PPSS patients were 75.4%, 50.8%, 41.8%, and 39.3%, respectively. Cancer-directed surgery was shown to improve the survival of PPSS patients with localized or regional stage (P < 0.05), yet surgical resection did not prolong the OS and DSS of patients with distant stage (P > 0.1). Postoperational radiotherapy was associated with shortened survival time (P < 0.05). PPSS patients who received lobectomy had statistically prolonged OS and DSS than those with pneumonectomy (P < 0.001).

CONCLUSIONS

PPSS is a rare and special subtype of synovial sarcoma. Treatment with lobectomy or sublobar resection alone may contribute to a superior prognosis compared with other managements.

Spontaneous Regression of Multiple Pulmonary Metastasis of Sacral Chordoma: A Case Report

CASE

A 53-year-old man was referred to our institution for the treatment of sacral chordoma and underwent a wide resection. Multiple lung metastases were observed in both the lungs, a year after the surgery, and the diagnosis was confirmed by biopsy. The patient refused treatment, and the lesions continued to increase in size gradually. However, 3 years and 6 months after the surgery, computed tomography of both the lungs showed spontaneous regression of the lesions without any obvious causes. The metastatic lung lesions had disappeared at the final follow-up, 7 years and 5 months after the multiple pulmonary metastases were diagnosed.

CONCLUSION

We report the first case of spontaneous regression of pathologically proven pulmonary metastases of a sacral chordoma.

Pancreatic enzyme autodigestion of an unresectable retroperitoneal liposarcoma

This is a case of a 71-year-old man who had multiple synchronous retroperitoneal liposarcoma (LPS) foci composed of both well-differentiated and dedifferentiated histologies. In addressing this, the patient underwent a margin negative resection of a 11.8×8.8 cm right-sided dedifferentiated LPS requiring pancreaticoduodenectomy; however, a 13.1×7.2 cm left-sided well-differentiated LPS (WDLPS) was not resected due to its involvement of the proximal mesenteric vessels. The patient's postoperative course was complicated by grade B postoperative pancreatic fistula involving the anatomical territory of the residual WDLPS. Over the next 12 months, serial CT scans demonstrated a stepwise reduction in size of the WDLPS until it completely regressed. The authors hypothesise that enzymes shed from the pancreatic fistula initiated the autodigestion and subsequent necrosis of the WDLPS with associated tumour regression.

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

Sarcoma is a malignant tumor arising from the mesenchymal tissues such as striated skeletal and smooth muscles, adipose tissue, bone, cartilage, and synovial tissue. The synovial subset of primary pulmonary sarcoma is very rare and is only described in a handful of cases. Our case describes the diagnostic approach and treatment regimen for a 49-year-old male with no significant past medical history. The diagnosis of a primary pulmonary synovial sarcoma was made through the use of endobronchial ultrasound (EBUS), transbronchial needle aspiration (TBNA), histologic analysis, and immunostaining. The treatment utilized a multimodal approach including resection, chemotherapy, and radiotherapy.

Primary renal synovial sarcoma: A case report

RATIONALE

Synovial sarcoma (SS) is a malignant neoplasm that arises from soft tissues proximal to the joints. It occurs primarily at the major joints of the extremities, but may also occur in the deep soft tissues around the joints. While primary renal synovial sarcoma (PRSS) is extremely rare, it is important to have a better understanding of their imaging and clinical features to establish an effective treatment plan. Correct identification of PRSS is also useful for treating renal neoplasms.

PATIENT'S CONCERNS

A 56-year-old Chinese man was admitted to our hospital due to moderate, paroxysmal left-sided loin pain.

DIAGNOSIS

Renal enhanced computed tomography (CT) scanning showed a relatively hypovascular lesion with calcification in the left kidney. A radical nephrectomy was performed in the left kidney. Postoperative pathology indicated SS with necrosis. The immunohistochemical findings were as follows: 34βE12 (Epithelium+), Bcl-2(+), CD99(+), CK-pan((Epithelium+), EMA(Epithelium+), Ki-67(+60%), and Vimentin(+), CD34(-).

INTERVENTIONS

The patient underwent radical left nephrectomy with no complications.

OUTCOMES

After discharge, a close review for 3 months showed no evidence of recurrence.

LESSONS

PRSS should be considered for the differential diagnosis of renal hypovascular tumors. When problems arise in distinguishing renal hypovascular tumors, surgical pathology is helpful in the final diagnosis and further treatment of the disease.

Primary pleural synovial sarcoma with repeated resection leading to long-term survival

Primary pleural synovial sarcoma is a malignant tumour and thought to be more aggressive than synovial sarcoma which occurs in extremities. Its treatment strategy has not been fully established because of its rarity. We report a primary pleural synovial sarcoma case which achieved a long-term survival with repeated surgery of recurrent pleural tumour. A 39-year-old man presented with a gradually enlarged tumour in the left hemithorax. The tumour was resected and diagnosed as primary pleural synovial sarcoma. The tumour was slowly growing and repeatedly recurrent in the left pleura. The surgical resections for the recurrent tumours were performed 6 years and 11 years after the initial surgery. Intriguingly, recurrent tumour which developed after second surgery exhibited temporally spontaneous regression. Our patient remains alive 12 years after the initial surgery. Repeated resection of metastatic lesion can achieve long survival in primary pleural synovial sarcoma.

LncRNA-135528 inhibits tumor progression by up-regulating CXCL10 through the JAK/STAT pathway

Spontaneous tumor regression can be observed in many tumors, however, studies related to the altered expression of lncRNA in spontaneous glioma regression are limited, and the potential contributions of lncRNAs to spontaneous glioma regression remain unknown. To investigate the biological roles of lncRNA-135528 in spontaneous glioma regression. The cDNA fragment of lncRNA-135528 was obtained by rapid-amplification of cDNA ends (RACE) technology and cloned into the plvx-mcmv-zsgreen-puro vector. Additionally, we stably silenced or overexpressed lncRNA-135528 in G422 cells by transfecting with siRNA against lncRNA-135528 or lncRNA-135528 overexpression plasmid. Then, we examined lncRNA-135528 overexpressing and lncRNA-135528 silencing on glioma cells and its effects on CXCL10 and JAK/STAT pathways. The main findings indicated that lncRNA-135528 promoted glioma cell apoptosis, inhibited cell proliferation and arrested cell cycle progression; the up-regulation of lncRNA135528 led to significantly increased CXCL10 levels and the differential expression of mRNA associated with JAK/STAT pathway in glioma cells. lncRNA-135528 can inhibit tumor progression by up-regulating CXCL10 through the JAK/STAT pathway.

Spontaneous Regression of Myxofibrosarcoma of the Thigh after Open Biopsy

Spontaneous regression of sarcoma is exceedingly rare. A 62-year-old male presented with myxofibrosarcoma of the thigh which regressed after open biopsy. Treatment strategy for this condition is not well-documented in the literature. In this report, we describe the case of a spontaneously regressed myxofibrosarcoma successfully treated by resection where the extent of the tumor was determined from the initial MRI. This case demonstrates that myxofibrosarcoma has the potential to regress spontaneously, and astute awareness of this phenomenon is necessary for appropriate management of this condition.