Fluoro deoxyglucose positron emission tomography-computerized tomography in primary staging and response assessment of a rare case of primary pleural synovial sarcoma

Our plain-English summary of Fluoro deoxyglucose positron emission tomography-computerized tomography in primary staging and response assessment of a rare case of primary pleural synovial sarcoma, by C.N. Harisankar, J. John, K.V. Gangadharan (Indian Journal of Nuclear Medicine, 2015).

The study

• Authors: C.N. Harisankar, J. John, K.V. Gangadharan
• Journal: Indian Journal of Nuclear Medicine
• Published: 2015;30(1):62-4
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pleural sarcomas constitute <1% of all primary lung cancers. Synovial sarcomas of the pleura are extremely rare. They may be mistaken for malignant mesothelioma or other spindle cell tumors, but the confirmation is by histology and immunohistochemistry. Synovial sarcomas are aggressive with a high incidence of recurrence. In this case report, we present the 18-fluoride-fluoro deoxyglucose (FDG) positron emission tomography-computerized tomography (PET-CT) findings of patient with primary pleural synovial cell sarcoma. The pretreatment and postchemotherapy FDG PET-CT scans are presented. The role of FDG PET-CT in initial staging and response assessment in this interesting case of pleural synovial sarcoma is presented.

In plain English

This case report described one patient, a 40-year-old man with one-sided chest pain and breathing difficulty who had large masses in the right pleura (the lining of the chest). A biopsy suggested synovial cell sarcoma of the pleura, a rare tumor the authors noted can be mistaken for malignant mesothelioma. The article does not mention asbestos. A whole-body FDG PET-CT scan showed an intensely active right chest mass growing into the chest wall, masses beside the heart, and uptake in the left collarbone that was uncertain for spread. The tumor could not be removed, so he received ifosfamide and adriamycin chemotherapy. After five cycles, a repeat scan showed the chest masses had shrunk and become less active but remained, and the collarbone uptake had resolved. The authors called this a favorable but incomplete response. He was referred for further chemotherapy and palliative radiation and had clinically stable disease at the time of writing. The authors concluded that PET-CT played a significant role in his care and that its role in synovial cell sarcoma needs further evaluation.

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 (single patient)
• Who was studied: One 40-year-old male with unilateral chest pain and breathing difficulty, found to have large right pleural soft tissue masses; biopsy suggestive of synovial cell sarcoma of the pleura. Authors are based in Kerala, India; dates of care not given.
• Exposure: Not reported. The article does not mention asbestos or any occupational or environmental exposure. It describes FDG PET-CT imaging before and after chemotherapy (ifosfamide + adriamycin).
• Main results:
  • Initial (pretreatment) PET-CT in this patient showed an intensely FDG avid soft tissue mass in the right thoracic cavity with chest wall infiltration, plus intensely FDG avid paracardiac soft tissue masses.
  • Initial PET-CT showed focal FDG uptake in the lateral end of the left clavicle, without obvious changes on CT, which was equivocal for metastases.
  • The disease was not resectable at diagnosis, so the patient received chemotherapy with ifosfamide and adriamycin.
  • After five cycles of chemotherapy, follow-up PET-CT showed significant reduction in size and metabolic activity of the pleural lesions, but residual pleural masses were still present.
  • The FDG uptake in the left clavicle had resolved on follow-up PET-CT.
  • The findings indicated a favorable but incomplete response; the patient was referred for further chemotherapy and palliative radiation and had clinically stable disease at the time of writing.
• The authors' conclusion: The authors stated that, to their knowledge, this was the first report of FDG PET-CT in response evaluation of primary pleural synovial sarcoma, that it played a significant role in this patient's initial evaluation and response assessment, and that its potential role in all patients with synovial cell sarcoma needs to be evaluated further.

Topics

Medical terms in this study, explained in our Lexicon: Staging, Synovial Sarcoma, Sarcoma, Lung Cancer, Pleura, Mesothelioma, Spindle Cell, Histology.

Related studies

• Fluorine-18 fluoro-2-deoxyglucose positron emission tomography/computed tomography in a case of suspected primary pericardial mesothelioma — R. Senthil, A. Bhattacharya, et al. (2012)
• 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography fused imaging in malignant mesothelioma patients: looking from outside is not enough — E. Roca, S. Laroumagne, et al. (2013)
• Positron emission tomography with f18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma — D.B. Schneider, C. Clary-Macy, et al. (2000)
• Use of computed tomography and positron emission tomography/computed tomography for staging of local extent in patients with malignant pleural mesothelioma — T. Frauenfelder, P. Kestenholz, et al. (2015)
• Positron Emission Tomography/Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It? — V. Pinelli, E. Roca, et al. (2015)
• Diagnostic Laparoscopy Improves Staging of Malignant Pleural Mesothelioma With Routine Positron Emission Tomography Imaging — R.T. Ripley, N. Palivela, et al. (2021)

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