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

Abstract

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.

Keywords: multimodal; pulmonary sarcoma.

Figure 1. CT/PET scan results

The images on the top left and top right show the bilobular, smooth borders of the sarcoma located in the left upper lobe of the lung. The images on the bottom left and bottom right detail the positron emission tomography (PET) scan results showing heterogeneous activity in the area of the mass. The blue arrows indicate the area of interest.

Figure 2. Histologic images obtained from the transbronchial needle aspiration (TBNA) sample

The image on the top left demonstrates features of the monophonic synovial sarcoma. The image on the top right shows positive Bcl-2 immunostaining of spindle cells. The images on the bottom left/right show elongated spindle cells with oval nuclei and minimal cytoplasm. The arrows indicate areas of interest.