Primary pulmonary biphasic synovial sarcoma: a case report and literature review

Primary synovial sarcomas of the lung are extremely rare, constituting 0.1% to 0.5% of lung cancers. The first case was reported by Gaertner in 1996.

We present the case of a 15-year-old female who presented with cough, white-colored secretions, right-sided chest pain and progressive dyspnea. Physical examination revealed increased exertion during breathing with no cyanosis. The presence of right scapular pulmonary condensation syndrome was observed. Chest x-ray demonstrated homogeneous opacity occupying the lower two thirds of the right hemithorax. Posterolateral thoracotomy with right lower and medium lobectomy was performed. Because there was evidence of upper lobe tumor, it was decided to carry out a right pneumonectomy. Histopathological diagnosis was biphasic synovial sarcoma.

The presentation of pulmonary synovial sarcoma generally shows a peripheral location with a nonencapsulated and well-circumscribed tumor. Size ranges from 0.6 to 17 cm (mean: 5 cm). Histology is often characterized by a monophasic pattern. Diagnosis is difficult except for a uniform spindle cell pattern. Most synovial sarcomas show immunoreactivity for cytokeratin and/or epithelial membrane antigen. Cytogenetic characteristic of synovial sarcoma are t(X; 18)(p11, q11). Patient prognosis for pulmonary synovial sarcoma is poor with an overall 5-year survival rate of 50%.