Primary Synovial Sarcoma of the Mediastinum : A Case Report

Abstract

Synovial sarcomas commonly occur in the extremities of young adults. A primary occurrence in the mediastinum is very rare with only a few reported cases in the world literature. This paper is about a 42-year-old male who presented with chest pain and dyspnoea on exertion. Imaging showed an anterior mediastinal mass with adhesions to the lung. Pathological examination of the resected mass showed a biphasic neoplasm with a spindle cell component admixed with gland-like elements. The tumour showed positive staining with cytokeratin, epithelial membrane antigen, and Bcl-2 confirming the diagnosis of a biphasic synovial sarcoma. A wide range of neoplasms, both primary and metastatic, occur in the mediastinum, which pose considerable diagnostic difficulties. A synovial sarcoma should always be considered in the differential diagnosis, and immunohistochemistry is an important adjuvant tool in this situation. This paper highlights the importance of recognizing an unusual presentation of this aggressive neoplasm to aid appropriate clinical management.

Primary giant mediastinal synovial sarcoma of the neck: A case report and review of the literature

“…With regard to clinical manifestations, mediastinal synovial sarcomas reveal various initial symptoms due to their different scopes of infringement. The common symptoms include chest pain ( 5 – 7 ), shortness of breath and dyspnea ( 8 , 9 ), in contrast to the present case whose initial symptom was the accidental identification of a neck lump, which is a rare clinical manifestation and is likely to be easily ignored and misdiagnosed. Therefore, it is important to combine imaging and pathology to assist in establishing a diagnosis.…”

“…The mass was significantly reduced following 6 cycles of neoadjuvant chemotherapy (ifosfamide and doxorubicin) followed by radical en bloc resection, and the patient exhibited no signs of disease recurrence following five years of routine follow-up examinations. The therapeutic regimen of ifosfamide and doxorubicin has been regularly used for the treatment of synovial sarcomas to prolong overall survival rates ( 6 , 7 , 9 , 17 ). The patient in the present case report also accepted 4 cycles of this combination regimen and the follow-up CT scans ( Fig.…”

Primary Synovial Sarcoma of the Mediastinum: A Case Report and Review of the Literature

“…Although synovial sarcoma has been reported to metastasis to the mediastinum, its occurrence as primary neoplasm in this location is rare and has only recently been recognized. Only a few reports and series of primary synovial sarcoma of the mediastinum are described in the literature and all reported cases does not exceed forty so far [2][3][4][6][7][8][9][10][11][12][13][14][15].…”

“…It had been reported some cases arising from the pericardium which posed difficulties for surgical resection [14,15].…”

Synovial sarcoma presenting with huge mediastinal mass: a case report and review of literature

“…In patients with resectable mediastinal disease, the prognosis seems to be worse than patients with resectable extremity synovial sarcomas, as most of the reported cases of mediastinal synovial sarcomas had local or distant recurrences following complete surgical resection [17,18]. This high rate of local and distant failure suggests that adjuvant multimodality therapy following resection might be warranted.…”