Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 5103-5110
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5103
Solitary primary pulmonary synovial sarcoma: A case report
Wei-Wei He, Zhi-Xin Huang, Wen-Jing Wang, Yu-Lei Li, Qiu-Yuan Xia, Yong-Bin Qiu, Yi Shi, Hui-Ming Sun
Wei-Wei He, Zhi-Xin Huang, Wen-Jing Wang, Yu-Lei Li, Yong-Bin Qiu, Hui-Ming Sun, Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, Nanjing 210000, Jiangsu Province, China
Qiu-Yuan Xia, Department of Pathology, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
Yi Shi, Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
Author contributions: He WW and Huang ZX acquired the medical report of the patient; Analysis and interpretation of data were performed by He WW, Huang ZX, Wang WJ, Qiu YB, Shi Y and Sun HM; Xia QY explained the histopathological results; He WW and Sun HM reviewed the Literature and drafted the paper; all authors read and approved the final paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Ming Sun, MD, Doctor, Department of Respiratory and Critical Care Medicine, Nanjing Yimin Hospital, No. 86 Shanggao Road, Nanjing 210000, Jiangsu Province, China. shm-icu@163.com
Received: December 22, 2021
Peer-review started: December 22, 2021
First decision: February 8, 2022
Revised: February 17, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 26, 2022
Processing time: 153 Days and 5.6 Hours
Abstract
BACKGROUND

Synovial sarcoma (SS) is an uncommon and highly malignant soft tissue sarcoma in the clinic, with primary pulmonary SS (PPSS) being extremely rare. Here, we describe the clinical characteristics, diagnosis, and treatment of a solitary PPSS case confirmed via surgical resection and fluorescence in situ hybridization (FISH).

CASE SUMMARY

A 33-year-old man was admitted because of intermittent coughing and hemoptysis for one month, with lung shadows observed for two years. Whole-body positron emission tomography-computed tomography (PET-CT) revealed a solitary mass in the upper lobe of the right lung, with uneven radioactivity uptake and a maximum standardized uptake value of 5.6. The greyish-yellow specimen obtained following thoracoscopic resection was covered with small multi-nodulated structures and consisted of soft tissue. Hematoxylin and eosin staining revealed spindle-shaped malignant tumor cells. Immunohistochemistry indicated these tumor cells were CD99 and BCL-2-positive. Furthermore, the FISH test revealed synovial sarcoma translocation genetic reassortment, which confirmed the diagnosis of SS.

CONCLUSION

PPSS is extremely rare and tends to be misdiagnosed as many primary pulmonary diseases. PET-CT, histologic analysis, and FISH tests can be used to differentiate PPSS from other diseases. Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.

Keywords: Primary pulmonary synovial sarcoma; Spindle cells; Fluorescence in situ hybridization; Synovial sarcoma translocation; Solitary pulmonary nodule; Positron emission tomography-computed tomography; Case report

Core Tip: Synovial sarcoma (SS) is an uncommon and highly malignant soft tissue sarcoma in the clinic, with primary pulmonary SS (PPSS) being extremely rare. It tends to be misdiagnosed as many primary pulmonary diseases. Here, we described the clinical characteristics, diagnosis, and treatment of a solitary PPSS case. Positron emission tomography-computed tomography, histologic analysis, and fluorescence in situ hybridization tests can be used to differentiate PPSS from other diseases. Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.