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Marak JR, Raj G, Khanna T, Singh P, Harsha G. Primary monophasic synovial sarcoma of the lung: Rare case report. Radiol Case Rep 2023; 18:2212-2218. [PMID: 37123038 PMCID: PMC10130694 DOI: 10.1016/j.radcr.2023.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 05/02/2023] Open
Abstract
Primary monophasic synovial sarcoma of the lung is an extremely rare malignant mesenchymal tumor that can develop at any anatomic site. Synovial sarcoma is considered a high grade tumor with a poor prognosis. Metastatic pulmonary sarcoma is much more common. Hence primary lesion elsewhere in the body needs exclusion. No clinical or radiological features are specific for pulmonary sarcoma, often it is confused with bronchogenic carcinoma. Therefore biopsy is needed to establish the diagnosis of this rare tumor. We hereby present two cases of histologically proven primary monophasic synovial sarcoma of lung. The imaging features of this rare disease is reviewed.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
- Corresponding author.
| | - Gaurav Raj
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Tanvi Khanna
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Pradyumn Singh
- Department of Pathology, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Gara Harsha
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
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2
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Abstract
We describe a case of primary pulmonary synovial sarcoma. A 19-year-old man presented with low-grade fever, dyspnea, chest pain and left arm numbness. Chest radiographs revealed a large, well-circumscribed left perihilar mass and a small ipsilateral pleural effusion. Chest computed tomography (CT) revealed a large well-defined, heterogeneous lung mass. Magnetic resonance imaging (MRI) demonstrated a mass of heterogeneous signal intensity on T1-weighted and proton density images, and high signal intensity on short tau inversion recovery (STIR) images. Whole-body bone scintigraphy showed no evidence of skeletal involvement. Abdominal and pelvic CT showed no intra-abominal or pelvic metastases. A CT-guided biopsy provided the diagnosis of monophasic synovial sarcoma. Following four cycles of chemotherapy, integrated F-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F FDG PET/CT) was performed, which demonstrated interval decrease in the size of the lesion and no significant metabolic activity. Surgical resection was then undertaken. Microscopically, the lesion was a high-grade spindle cell sarcoma consistent with monophasic synovial sarcoma. A variant X;18 translocation was identified by cytogenetic analysis and confirmed with metaphase in situ hybridization. The imaging and pathological features of this rare lesion are reviewed.
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3
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Nuwal P, Dixit R, Shah NS, Samaria A. Primary monophasic synovial sarcoma lung with brain metastasis diagnosed on transthoracic FNAC: Report of a case with literature review. Lung India 2012; 29:384-7. [PMID: 23243358 PMCID: PMC3519030 DOI: 10.4103/0970-2113.102841] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Synovial sarcoma is highly malignant tumor of soft tissues, occurring chiefly in the extremities and limb girdle with a propensity for local recurrence and sometimes metastases to the lungs. Primary synovial sarcoma arising in the lungs is rare and brain metastasis as presentation is further uncommon. We report a case of primary monophasic synovial sarcoma lung presenting with brain metastasis in a 35-year-old male patient. The diagnosis was made on percutaneous transthoracic needle aspiration from left-sided pulmonary mass and later confirmed by immunohistochemistry. The utility of preoperative diagnosis by percutaneous aspiration cytology is also stressed.
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Affiliation(s)
- Paras Nuwal
- Department of Pathology, J. L. N. Medical College, Ajmer, Rajasthan, India
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Devarakonda VS, Lembert L, Entwistle JW, Hoag JB. Primary synovial sarcoma of the lung with intra-cardiac extension. ACTA ACUST UNITED AC 2010; 81:249-52. [PMID: 20714127 DOI: 10.1159/000320112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 04/14/2010] [Indexed: 11/19/2022]
Abstract
Synovial sarcomas are a distinct clinical entity occurring most often in the lower extremities. They account for 10-14% of all soft tissue sarcomas. Pulmonary synovial sarcomas are quite rare and account for less than 0.5% of all intra-thoracic neoplasms. We present the first reported case of primary pulmonary synovial sarcoma with intra cardiac extension in a 53-year-old male who presented with chronic cough. Imaging revealed a large right upper lobe mass extending through the superior pulmonary veins into the left atrium. The patient underwent a right total pneumonectomy with extraction of the left atrial mass and left atrial reconstruction. Pathology and immunohistochemistry was diagnostic of primary pulmonary synovial sarcoma positive for SYT-SSX1 gene fusion transcription.
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Affiliation(s)
- Veena S Devarakonda
- Division of Pulmonary, Critical Care and Sleep Medicine, Drexel University College of Medicine, Philadelphia, Pa. 19102, USA.
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5
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Cystic Primary Pulmonary Synovial Sarcoma Presenting as Recurrent Pneumothorax: Report of 4 Cases. Am J Surg Pathol 2010; 34:1176-9. [DOI: 10.1097/pas.0b013e3181e85c87] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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A Reappraisal of Hemangiopericytoma of Bone; Analysis of Cases Reclassified as Synovial Sarcoma and Solitary Fibrous Tumor of Bone. Am J Surg Pathol 2010; 34:777-83. [DOI: 10.1097/pas.0b013e3181dbedf1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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7
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Betal D, Babu R, Mehmet V. Monophasic synovial sarcoma of the pharynx: a case report. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2009; 6:9. [PMID: 19335917 PMCID: PMC2670314 DOI: 10.1186/1477-7800-6-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 03/31/2009] [Indexed: 01/25/2023]
Abstract
Synovial sarcomas are a rare form of soft tissue sarcomas. We present a case of a 62 year-old male presenting with a left thyroid lump initially though to be a thyroid adenoma but subsequently diagnosed as a monophasic synovial sarcoma of the pharynx. We discuss the diagnosis and treatment of this case.
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Affiliation(s)
- Dibendu Betal
- Department of Surgery, St Mary's Hospital, Isle of Wight NHS Trust, Parkhurst Road, Newport, Isle of Wight, PO30 5TG, UK.
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Mirzoyan M, Muslimani A, Setrakian S, Swedeh M, Daw HA. Primary pleuropulmonary synovial sarcoma. Clin Lung Cancer 2008; 9:257-61. [PMID: 18824448 DOI: 10.3816/clc.2008.n.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pleuropulmonary synovial sarcoma (PPSS) is increasingly recognized as a subtype of sarcoma because of the recent identification of a distinctive chromosomal translocation specific to synovial sarcoma. Soft-tissue synovial sarcoma is far more common than PPSS and typically develops in para-articular locations of the extremities, affects young and middle-aged adults, with no difference in distribution between the sexes, and has well-documented radiologic manifestations. Pleuropulmonary synovial sarcoma can arise in the chest wall, heart, mediastinum, pleura, or lung, and it shares patient demographics and several imaging features with its soft-tissue counterpart. Patients present with a cough, chest pain, or dyspnea. On chest radiographs, PPSS typically appears as a sharply marginated mass with uniform opacity, based in the pleura or in the lung, and often accompanied by an ipsilateral pleural effusion. Computed tomographic images show a well-circumscribed, heterogeneously enhanced lesion without associated involvement of bone and without calcifications (except in the case of a chest wall primary tumor). Magnetic resonance imaging provides superior demonstration of nodular soft tissue and multilocular fluid-filled internal components of PPSS, in addition to peripheral rim enhancement after the intravenous administration of a gadoliniumbased contrast material such as gadopentetate dimeglumine. Current treatment consists of surgical resection followed by chemotherapy, radiation therapy, or both.
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Affiliation(s)
- Michael Mirzoyan
- Department of Medicine, Fairview Hospital, Cleveland, OH 44111, USA
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Cascales P, Gómez-Caro AA, Ferri-Níguez B, Roca MJ, Torres J, Parrilla P. Poorly differentiated primary monophasic synovial sarcoma of the lung. Asian Cardiovasc Thorac Ann 2008; 14:511-3. [PMID: 17130329 DOI: 10.1177/021849230601400614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary monophasic synovial sarcoma of the lung is rarely seen in clinical practice. We report the case of a 60-year-old male who underwent a left lower lobectomy for lung sarcoma. The patient received adjuvant therapy after surgery. Diagnosis was confirmed with SYT-SSX2 translocation detection.
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Affiliation(s)
- Pedro Cascales
- Department of Thoracic Surgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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10
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Hinterberger M, Reineke T, Storz M, Weder W, Vogt P, Moch H. D2-40 and calretinin - a tissue microarray analysis of 341 malignant mesotheliomas with emphasis on sarcomatoid differentiation. Mod Pathol 2007; 20:248-55. [PMID: 17361207 DOI: 10.1038/modpathol.3800736] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anti-calretinin antibodies are useful to differentiate adenocarcinomas from malignant mesotheliomas of the lung. Therefore, calretinin expression is rarely reported for sarcomatoid mesotheliomas. Anti-podoplanin antibodies (eg D2-40) react with lymphatic endothelia, Kaposi's sarcoma, lymphangioma and mesotheliomas. For the interpretation of spindle cell lesions of the pleura, knowledge of calretinin and D2-40 expression frequencies in sarcomatoid mesothelioma is desirable. To systematically investigate the sensitivity of calretinin and D2-40 antibodies in epithelioid and sarcomatoid areas of malignant mesotheliomas, a tissue microarray with 341 malignant mesotheliomas, including 112 epithelioid, 46 sarcomatoid and 183 biphasic tumors was constructed. Epithelioid and sarcomatoid differentiated tumor areas were clearly separated within the tissue microarray. Expression of calretinin and D2-40 was separately studied in epithelioid and sarcomatoid areas by immunohistochemistry. Calretinin expression was found in 91% of epithelioid and 57% of sarcomatoid tumor areas. D2-40 immunostaining was present in 66% of the epithelioid and 30% of the sarcomatoid tumor areas. A combination of calretinin and D2-40 increased the sensitivity in epithelioid tumor areas to 0.96 and in sarcomatoid tumor areas to 0.66. These data indicate that a combination of calretinin and D2-40 will improve diagnostic accuracy for spindle cell lesions of the pleura, whereas almost all epithelioid mesotheliomas are identified by calretinin alone.
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Affiliation(s)
- Marc Hinterberger
- Department of Pathology, Institute for Surgical Pathology, University Hospital of Zurich, Zurich, Switzerland
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11
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Abstract
Although well established as a marker of mesothelial cells, calretinin is also expressed in several other tissue types, including adipose tissue. Accordingly, immunohistochemical staining for calretinin has been described in an increasing number of neoplasms other than mesothelioma. A detailed analysis of calretinin expression in lipogenic tumors has not yet been reported, however. Given the known expression patterns of calretinin in normal tissues, we predicted that calretinin immunoreactivity would be detected in lipoma and the various histologic subtypes of liposarcoma, and that this marker might be of use in the differential diagnosis of selected fatty tumors. A variety of pleomorphic and small round cell sarcomas were studied for comparison. Calretinin immunoreactivity was detected, at least focally, in all 10 samples of normal adipose tissue and in 22 of 23 lipomas or lipoma variants. Staining for calretinin was also positive within the lipogenic component of 28 of 29 liposarcoma variants. Of the 7 dedifferentiated liposarcomas, 3 were focally positive for calretinin. Pleomorphic variants of other sarcomas, including undifferentiated high-grade pleomorphic sarcoma, rhabdomyosarcoma, leiomyosarcoma, and malignant peripheral nerve sheath tumor also exhibited focal calretinin immunoreactivity in a minority of cases, as did some small round cell sarcomas. These results suggest that calretinin immunoreactivity in normal and neoplastic adipose tissue is more ubiquitous than previously reported and may be a useful, albeit nonspecific marker of lipogenic differentiation. However, its utility in the differential diagnosis of fatty tumors appears limited.
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Affiliation(s)
- Justin M M Cates
- Department of Pathology, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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12
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Abstract
Pleuropulmonary synovial sarcoma (PPSS) is increasingly recognized as a subtype of sarcoma because of the recent identification of a distinctive chromosomal translocation specific to synovial sarcoma. Soft-tissue synovial sarcoma is far more common than PPSS and typically develops in para-articular locations of the extremities; affects young and middle-aged adults, with no difference in distribution between the sexes; and has well-documented radiologic manifestations. PPSS may arise in the chest wall, heart, mediastinum, pleura, or lung, and it shares patient demographics and several imaging features with its soft-tissue counterpart. Patients present with a cough, chest pain, or dyspnea. On chest radiographs, PPSS typically appears as a sharply marginated mass with uniform opacity, based either in the pleura or in the lung, and often accompanied by an ipsilateral pleural effusion. Computed tomographic images show a well-circumscribed heterogeneously enhanced lesion without associated involvement of bone and without calcifications (except in the case of a chest wall primary tumor). Magnetic resonance imaging provides superior demonstration of nodular soft tissue and multilocular fluid-filled internal components of PPSS, in addition to peripheral rim enhancement after the intravenous administration of a gadolinium-based contrast material such as gadopentetate dimeglumine. Current treatment consists of surgical resection followed by chemotherapy, radiation therapy, or both.
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Affiliation(s)
- Aletta Ann Frazier
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th St and Alaska Ave NW, Washington, DC 20306-6000, USA.
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MESH Headings
- Adult
- Antineoplastic Agents, Alkylating/therapeutic use
- Biomarkers, Tumor/analysis
- Chemotherapy, Adjuvant
- Chromosomes, Human, Pair 18
- Chromosomes, Human, X
- Humans
- Ifosfamide/therapeutic use
- Male
- Pleura/pathology
- Pleural Neoplasms/chemistry
- Pleural Neoplasms/diagnosis
- Pleural Neoplasms/genetics
- Pleural Neoplasms/therapy
- Proto-Oncogene Proteins c-bcl-2/analysis
- Sarcoma, Synovial/chemistry
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/therapy
- Thoracic Surgical Procedures
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Lori Eichelberger
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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