Synovial sarcoma of the chest wall: a case report and literature review

A Case report: Synovial sarcoma of the mediastinum in an 18-year-old teenager

Synovial sarcomas (SSs) are a rare group of malignant tumors originating from pluripotential mesenchymal cells, which commonly occur as the primary tumor in the soft tissues near the articular surface, tendons, and articular synovium. Herein, we report a rare case of mediastinal SS in an 18-year-old teenager who initially presented with cough as the primary symptom. In this case, plain chest CT and contrast-enhanced CT clearly revealed the lesion presenting as a round-like and uneven density mass in the mediastinum with heterogeneous enhancement, which compressed the trachea and invaded the adjacent vessels. Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), combined with the differential diagnosis with other types of tumors in the mediastinum on imaging, we were able to diagnose the tumor as an SS located in the mediastinum. Subsequent resection of the lesion coupled with chemotherapy and immunotherapy led to an improvement in the patient's symptoms.

Chest Wall Monophasic Synovial Sarcoma in a 12-Year-Old Boy: A Case Report

We report a rare case of synovial sarcoma of the chest wall in a child. A 12-year-old male presented to our pediatric surgery department with chief complaint of swelling accompanied by slight pain of the upper right side of the anterior chest wall since approximately 5 months. Firstly, we performed an ultrasound (US)-mass biopsy. Histopathological examination showed fibromatosis. After that, we underwent surgical resection. Pathological examination revealed a monophasic type synovial sarcoma. Immediately post-operation, the patient manifested a loss of the extension of the forearm, hand, and fingers on the right side. Physical therapy was performed with good results. On the basis of our diagnosis, we performed 6 cycles of multi-drug adjuvant chemotherapy and then radiotherapy. After 3 years of surgery, there was no evidence of recurrence. However, careful observation may be required.

A rare case of pleuropulmonary synovial sarcoma of the chest wall: A case report and a literature review

Pleuropulmonary synovial sarcoma is a subtype of synovial sarcomas that commonly arises from the chest wall, pleura, lungs and the heart. They are extremely rare, with only a few cases reported in the literature. It usually affects young and middle-aged adults with no gender predilection. Chest radiographs usually show a pleural-based mass, parenchymal consolidation, or a near complete opacification of the hemithorax. On contrast-enhanced CT, synovial sarcomas of the chest wall typically appear as a well-defined, heterogeneously enhancing mass with bone destruction and infiltration of chest wall musculature. MRI usually demonstrates a heterogeneous mass with areas of both high and low T1 signal intensities representing areas of hemorrhage and necrosis. We report a case of a 39- year old African male patient who presented to our hospital complaining of chest pain of 4 months duration. The plain chest radiograph showed complete opacification of the left hemithorax. Contrast-enhanced CT and MRI were then performed revealing a large left-sided heterogeneous mass. PET-CT demonstrated avid FDG uptake in the solid components of the mass with no evidence of distant metastasis._. An ultrasound-guided biopsy was performed, and histopathology revealed a locally advanced primary synovial sarcoma of the chest wall. Treatment consisted of neoadjuvant chemotherapy followed by surgical resection.

Synovial Sarcoma of the Anterior Chest Wall: A Case Report

Synovial sarcoma is a malignant soft tissue tumor that usually involves the extremities, particularly near the knees; a synovial sarcoma originating in the chest wall is extremely rare. We describe a 26-year-old woman diagnosed with a synovial sarcoma originating in the chest wall, based on CT and MRI findings. Contrast-enhanced CT images revealed a small, well-defined enhancing mass with calcification, in the subpleural area. This lesion was initially diagnosed as a benign tumor; however, the patient developed sudden severe pain with spontaneous bleeding and hemothorax, suggesting the possibility of malignancy. MRI revealed a multilobulated mass with a fluid-fluid level, which characterizes a synovial sarcoma.

Multidisciplinary Assessment of Planning and Resection of Complex Bone Tumor Using Patient-Specific 3D Model

Oncological interventions in thoracic cavity have some important problems such as choice of correct operative approaches depending on the tumor, size, extension, and location. In sarcoma surgery, wide resection should be aimed for the curative surgery. Purpose of this study was to evaluate pre-operative planning of patient-specific thoracic cavity model made by multidisciplinary surgeon team for complex tumor mass for oncological procedures. Patient's scans showed a large mass encroaching on the mediastinum and heart, with erosion of the adjacent ribs and vertebral column. Individual model of this case with thoracic tumor was reconstructed from the DICOM file of the CT data. Surgical team including six interdisciplinary surgeons explained their surgical experience of the use of 3D life-size individual model for guiding surgical treatment. Before patients consented to surgery, each surgeon explained the surgical procedure and perioperative risks to her. A questionnaire was applied to 10 surgical residents to evaluate the 3D model's perception. 3D model scans were useful in determining the site of the lesion, the exact size, extension, attachment to the surrounding structures such as lung, aorta, vertebral column, or vascular involvement, the number of involved ribs, whether the diaphragm was involved also in which order surgeons in the team enter the surgery. 3D model's perception was detected statistical significance as < 0.05. Viewing thoracic cavity with tumor model was more efficient than CT imaging. This case was surgically difficult as it included vital structures such as the mediastinal vessels, aorta, ribs, sternum, and vertebral bodies. A difficult pathology for which 3D model has already been explored to assist anatomic visualization was mediastinal osteosarcoma of the chest wall, diaphragm, and the vertebral column. The study helped to establish safe surgical line wherever the healthy tissue was retained and enabled osteotomy of the affected spinal corpus vertically with posterior-anterior direction by preserving the spinal cord and the spinal nerves above and distal the tumor. 3D tumor model helps to transfer complex anatomical information to surgeons, provide guidance in the pre-operative planning stage, for intra-operative navigation and for surgical collaboration purposes. Total radical excision of the bone tumor and reconstructions of remaining structures using life-size model was the key for successful treatment and better outcomes. The recent explosion in popularity of 3D printing is a testament to the promise of this technology and its profound utility in orthopedic oncological surgery.

A Case of Primary Intra-abdominal Synovial Sarcoma

Synovial sarcomas are relatively common intermediate-to-high-grade malignant soft tissue tumors, often with an initial indolent course. And among the sarcomas primary intra-abdominal synovial sarcoma is a relatively rare entity that may present with an abdominal mass and diagnosis is usually confirmed by immunohistochemistry. The authors report a case of a 46-year-old man who presented with a large palpable abdominal mass. Contrast-enhanced computed tomography (CT) scan showed a large well-defined heterogeneous intra-abdominal mass filling the entire pelvis and extending upwards till the subhepatic region causing displacement of intra-abdominal organs. However, no other focal lesions were seen in the solid organs. The same findings were confirmed on surgery. Histopathology was suggestive of desmoid tumor/hemangiopericytoma. Immunohistochemistry showed positive markers corresponding to synovial sarcoma. The patient was advised to undergo chemotherapy which was refused and follow-up was lost. After 10 months, patient presented for follow-up CT, which showed marked increase in size of the lesion.

Utility and reproducibility of 3-dimensional printed models in pre-operative planning of complex thoracic tumors

BACKGROUND AND OBJECTIVES

3D-printed models are increasingly used for surgical planning. We assessed the utility, accuracy, and reproducibility of 3D printing to assist visualization of complex thoracic tumors for surgical planning.

METHODS

Models were created from pre-operative images for three patients using a standard radiology 3D workstation. Operating surgeons assessed model utility using the Gillespie scale (1 = inferior to 4 = superior), and accuracy compared to intraoperative findings. Model variability was assessed for one patient for whom two models were created independently. The models were compared subjectively by surgeons and quantitatively based on overlap of depicted tissues, and differences in tumor volume and proximity to tissues.

RESULTS

Models were superior to imaging and 3D visualization for surgical planning (mean score = 3.4), particularly for determining surgical approach (score = 4) and resectability (score = 3.7). Model accuracy was good to excellent. In the two models created for one patient, tissue volumes overlapped by >86.5%, and tumor volume and area of tissues ≤1 mm to the tumor differed by <15% and <1.8 cm2 , respectively. Surgeons considered these differences to have negligible effect on surgical planning.

CONCLUSION

3D printing assists surgical planning for complex thoracic tumors. Models can be created by radiologists using routine practice tools with sufficient accuracy and clinically negligible variability.

A giant pleural poorly differentiated synovial sarcoma (PDSS) in a 64-year-old woman

The article presents the rare case of a 64-year-old woman, who was admitted to our thoracic surgery department with a giant tumor in a right hemithorax measuring 88 mm × 137 mm × 188 mm, revealed by a thoracic CT scan. An anterolateral thoracotomy with a radical tumor resection was performed. The final pathological diagnosis of the poorly differentiated synovial sarcoma (PDSS) was made. The adjuvant radiotherapy of 60 Gy in 30 fractions was applied postoperatively. One year after operation patient remains in good health. The literature review on pleural synovial sarcoma has been shortly presented.

Primary pulmonary synovial sarcoma: A case report and review of literature

Primary pulmonary synovial sarcoma is a very rare, but highly aggressive tumor. Metastatic pulmonary sarcoma due to hematogenous dissemination is much more common. Hence why in any case of pulmonary sarcoma, whole body survey is necessary to exclude a primary tumor elsewhere. No clinical or radiological presentations are specific for pulmonary sarcoma hence; it is often confused with bronchogenic carcinoma. On the other hand, image-guided fine needle aspiration cytology (FNAC) is very much helpful in diagnosis of bronchogenic carcinoma, whereas, it may be inclusive in cases pulmonary sarcomas including primary synovial sarcoma, especially in cases of huge pulmonary masses. So why image-guided tru-cut core biopsy or open lung biopsy and their histopathological examination, supplemented by immunohistochemistry are preferable for the tissue diagnosis of pulmonary synovial sarcoma, although FNAC and immunocytochemistry may be used for the diagnosis. Surgical resection is treatment of choice, if it is not possible, palliative chemotherapy may be an option. Here, we report a rare case of primary synovial sarcoma which occupied almost whole of the right hemithorax in a 60-year-old male farmer.