A Pulmonary Zebra: Adult Primary Pulmonary Synovial Sarcoma

Our plain-English summary of A Pulmonary Zebra: Adult Primary Pulmonary Synovial Sarcoma, by S. Sandra, N. Chidi, A. Tracy (Case Reports in Oncological Medicine, 2022).

The study

• Authors: S. Sandra, N. Chidi, A. Tracy
• Journal: Case Reports in Oncological Medicine
• Published: 2022;2022:8649540
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pulmonary synovial sarcoma (PPSS) is an extremely rare tumor, with approximately 50 cases being reported in the English literature (Golota et al., 2018). Difficulties are often encountered in the diagnosis of PPSS as it can be confused with other spindle or round cell tumors, such as fibrosarcoma, hemangiopericytoma, mesothelioma, sarcomatoid carcinoma, or metastatic sarcomas. PPSS was first described by Zeren et al. in 1995. We present a case of PPSS in a 41-year-old woman, who complained of progressive dyspnea and left-sided chest pain.

Copyright © 2022 Sheffield Sandra et al.

In plain English

This article was a case report about one patient with primary pulmonary synovial sarcoma, a rare cancer that starts in the lung. It did not study asbestos or any other exposure. Mesothelioma appeared only as one of the tumors this cancer can be mistaken for. The patient was a 41-year-old woman of Indian descent with no significant past medical history and no history of tobacco, alcohol or illicit drug use. She came to the emergency room after two months of worsening shortness of breath on exertion and sharp chest pain. A chest CT scan showed a large mass involving the left chest and the mediastinum (the central part of the chest). A biopsy taken through a scope inserted into the chest showed an infiltrating spindle cell tumor. Laboratory staining found that the tumor cells carried the markers EMA, CD99, BCL-2 and calponin, but not cytokeratin or S-100. The article did not describe her treatment. It stated that the patient is deceased. The authors concluded that this tumor is very rare and aggressive, should be considered when lung and pleural masses are evaluated, and that its poor prognosis makes prompt diagnosis and treatment imperative.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 41-year-old woman of Indian descent with no significant past medical history and no history of tobacco, alcohol or illicit drug use, seen in an emergency room (authors based at UF College of Medicine, Jacksonville, Florida, USA)
• Exposure: Not reported; the article describes no asbestos, occupational or environmental exposure for the patient
• Main results:
  • The patient had a 2-month history of progressive shortness of breath on exertion and sharp, pleuritic chest pain
  • A chest CT scan showed a large mass involving the left chest and mediastinum
  • A thoracoscopic biopsy of the lung mass showed an infiltrating spindle cell neoplasm
  • Tumor cells were positive for EMA, CD99, BCL-2 and calponin, and negative for cytokeratin and S-100
  • The article states that the patient is deceased; treatment and clinical course were not described
• The authors' conclusion: The authors concluded that primary pulmonary synovial sarcoma is a very rare and aggressive tumor that should be included in the differential diagnosis of lung and pleural masses, and that because of its poor prognosis prompt diagnosis and treatment are imperative.

Topics

Medical terms in this study, explained in our Lexicon: Synovial Sarcoma, Mesothelioma, Sarcomatoid, Carcinoma, Sarcoma, Dyspnea.

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• Synovial sarcoma of the pleura and its differentiation from other primary pleural tumours: a clinicopathological and immunohistochemical review of three cases — A.G. Nicholson, P. Goldstraw, et al. (1998)
• TLE1 is expressed in the majority of primary pleuropulmonary synovial sarcomas — L.S. Lino-Silva, J.P. Flores-Gutiérrez, et al. (2011)
• Large primary pleural synovial sarcoma with severe dyspnea: a case report — M. Yamaki, S. Yonehara, et al. (2017)
• Fluoro deoxyglucose positron emission tomography-computerized tomography in primary staging and response assessment of a rare case of primary pleural synovial sarcoma — C.N. Harisankar, J. John, et al. (2015)
• Comments and Illustrations of the European Federation of Societies for Ultrasound in Medicine (EFSUMB) Guidelines: Rare Malignant Pulmonal and Pleural Tumors: Primary Pulmonary Sarcoma and Mesothelioma, Imaging Features on Transthoracic Ultrasound — K. Möller, F. Dietz, et al. (2024)

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