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Area of Science:

  • Oncology
  • Pathology

Background:

  • Primary pleural synovial sarcoma is exceptionally rare, with fewer than 40 reported cases.
  • Cystic synovial sarcoma is even rarer, with only 3 previously reported cases, including those from non-pleural sites.

Observation:

  • A 25-year-old male presented with hemoptysis, later diagnosed with cystic synovial sarcoma originating from the mediastinal visceral pleura.
  • Contrast-enhanced computed tomography (CT) imaging showed difficulty in distinguishing cystic synovial sarcoma from cystic thymoma due to the mediastinal location.

Findings:

  • Histopathological examination revealed tumor cells with spindled morphology, hypercellularity, and nuclear atypia.
  • Immunohistochemistry confirmed the diagnosis of synovial sarcoma by detecting CD99 and epithelial membrane antigen (EMA), while other markers were negative.
  • Fluorescence in situ hybridization (FISH) was not performed.

Implications:

  • This case underscores the diagnostic challenges of mediastinal cystic synovial sarcoma, particularly differentiating it from thymoma based on imaging alone.
  • Accurate diagnosis relies on histopathology and immunohistochemistry, crucial for appropriate oncological management.
  • Further research into rare thoracic sarcomas may improve diagnostic accuracy and treatment strategies.