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

Abstract

Background: Synovial sarcomas most commonly occur in the soft tissues of the extremities of young adults. A primary occurrence in the mediastinum is very rare with only a few reported cases in the world literature. Study aims: to insist on the rarity of this pathology, its imaging features and the importance for recognizing unusual presentation of this aggressive neoplasm to aid appropriate clinical management. Cases: Here in, we report a rare case of primary monophasic spindle cell synovial sarcoma of the mediastinum in a 31-year-old man who had an incidental finding of such a tumor. The imaging studies on admission showed 12 cm anterior-middle mediastinal mass with multiple metastases in the lung, pleura, mediastinal lymph nodes and spine. An ultrasound-guided percutaneous needle biopsy of a cervical extension of the mass permitted histopathology and immuno histochemical analysis which supported the diagnosis of monophasic spindle cell synovial sarcoma. The patient was treated by chemo-therapy without response. Conclusion: A wide range of neoplasms both primary and metastatic occurs in the mediastinum which poses considerable diagnostic difficulties. A synovial sarcoma should be considered in the differential diagnosis. Imaging can guide percutaneous needle biopsy of the tumor and evaluate its stage. Immunohistochemistry can be very helpful for an accurate diagnosis. Figure 1: PA and lateral chest x ray show a mass of the anterior-middle mediastinum displacing the trachea to the right side with multiple metastatic pulmonary nodules.

Rare Case of Mediastinal Synovial Sarcoma in an Indonesian Woman

“…Peripheral calcifications were described in some cases. In advanced stages, invasion and infiltration of surrounding tissue, and ipsilateral pleural effusion may be presented (6) .…”

Corporate Social Responsibility in Morocco: Global Perspectives and Local Application

“…For his part, Archie Carroll enriched the definition of CSR in 1979 by introducing a broader framework. He suggested that CSR encompasses not only the economic and legal responsibilities of business, but also ethical and discretionary aspects, creating a more holistic approach to CSR [18]. ISO 26000, published in 2010, offers a guide to CSR, defining it as an organization's responsibility for the impacts of its decisions and activities on society and the environment.…”

A rare case of a young man with mediastinal synovial sarcoma

“…It primarily occurs in soft tissues of the extremities, often near joint capsules and tendon sheaths, but also can occur in other areas of the body, including the mediastinum [ 1 ]. Although it is known as "synovial", it does not originate from synovial tissue but rather from pluripotent mesenchymal tissue which commonly found in tendons and joint fibers [ 2 ].…”

“…Immunohistochemistry is ideal for distinguishing these subtypes. SS is positive for epithelial membrane antigen (EMA), bcl-2, CD99, S-100, and vimentin and negative for myoD1 and myogenin [ 2 ]. More than 95% of SS cases have the t(X; 18)(p11; q11) translocation, resulting in SS18-SSX fusion genes [ 4 ].…”

“…High-dose doxorubicin (e.g., adriamycin regimen combined with ifosfamide) is recommended for more than three cycles in high-risk patients [ 6 ]. The combination of doxorubicin-ifosfamide is also suggested as adjuvant therapy for recurrent tumors [ 2 ].…”