Primary pleuropulmonary synovial sarcoma mimicking a carcinoid tumor: Case report and literature review

Abstract

Primary pleuropulmonary synovial sarcoma is a rare malignancy. Commonly described radiologic features in the literature include pleural disease and/or effusion, lack of calcification and high uptake on positron emission tomography computerised tomography. A 68-year-old woman presented with a 3-month history of cough. Imaging studies showed a right upper lobe mass with internal foci of calcification, endobronchial extension, and low fluorodeoxyglucose avidity on positron emission tomography computerised tomography, leading to an initial diagnosis of carcinoid tumor. However, histologic specimens suggested an unexpected diagnosis of aggressive synovial sarcoma, and the case was referred to the sarcoma MDT. Metastatic synovial sarcoma was ruled out, and radical surgical excision of the lesion was performed. This article highlights the multiple atypical features of primary pleuropulmonary synovial sarcoma as seen in this case and reviews imaging findings described in the literature. Radiologists should be aware of this unusual yet aggressive type of sarcoma.

Keywords: Primary pleuropulmonary synovial sarcoma; Synovial sarcoma.

Fig. 1

PPSS in a 68-year-old woman. Posteroanterior chest radiograph demonstrating right upper zone well defined mass abutting the right trachea. There is volume loss of the right upper lobe with tracheal shift to the right.

Fig. 2

PPSS in a 68-year-old woman. (A) Axial contrast-enhanced CT scan of the thorax demonstrating a well defined, heterogeneous mass in the right upper lobe with internal septation, and peripheral thin enhancing rim. (B) Coronal-reconstructed image shows multiple well-defined foci of calcification.

Fig. 3

PPSS in a 68-year-old woman. (A) Axial contrast-enhanced CT scan of the thorax (lung window) showing right upper lobe bronchus endobronchial tumor extension and associated right upper lobe anterior segment atelectasis. (B) Sagittal-reconstructed image (lung window) showing the position of the tumor in the posterior segment of right upper lobe abutting the oblique fissure with atelectasis of the anterior segment of right upper lobe.

Fig. 4

PPSS in a 68-year-old woman. (A, B) Fused axial images of positron emission tomography computerised tomography scan showing low fluorodeoxyglucose avidity of the right upper lobe tumor with endobronchial extension and a focus of calcification.