EC Pulmonology and Respiratory Medicine

Primary pulmonary synovial sarcoma (PPSS) is an exceptionally rare and aggressive malignant tumor, accounting for less than 0.5% of all primary lung neoplasms. We report the case of a 32 year-old female presenting with progressive dyspnea and intense chest pain. Imaging revealed a large, well-defined pulmonary mass with heterogeneous enhancement and areas of necrosis on contrast-enhanced computed tomography (CT). No extra pulmonary primary lesion was identified. Histopathological analysis confirmed monophasic synovial sarcoma, supported by immunohistochemical positivity for epithelial membrane antigen (EMA) and cytokeratin, and detection of the SYT-SSX fusion transcript. This case highlights the critical role of imaging in the evaluation of unusual pulmonary masses and the importance of considering PPSS in the differential diagnosis, especially in younger patients. Early recognition is essential given its aggressive nature and poor prognosis.

 Keywords: Primary Pulmonary Synovial Sarcoma; Lung Mass; Computed Tomography, Rare Tumor

1. Pandey L., et al. “Primary synovial sarcoma of the lung: a rare presentation, diagnostic dilemma and review of literature”. BMJ Case Reports11 (2020): e237678.
2. Gupta A., et al. “Pulmonary synovial sarcoma”. Respiratory Medicine Case Reports 25 (2018): 309-310.
3. Ammar A., et al. “Une localisation primitive inhabituelle du synovialosarcome: le poumon”. Revue des Maladies Respiratoires 3 (2006): 285-287.
4. Dermawan JKT and Policarpio-Nicolas MLC. “Cytological findings of monophasic synovial sarcoma presenting as a lung mass: report of a case and review of the literature”. Diagnostic Cytopathology 9 (2019): 948-955.
5. Eilber FC and Dry SM. “Diagnosis and management of synovial sarcoma”. Journal of Surgical Oncology 4 (2008): 314-320.
6. Satoh H., et al. “Primary synovial sarcoma of the chest wall”. Journal of Thoracic Oncology 11 (2007): 1060.
7. Eisenberg RB and Horn RC. “Synovial sarcoma of the chest wall report of a case”. Annals of Surgery 2 (1950): 281-286.
8. Bui-Mansfield LT., et al. “Radiologic-pathologic conference of Keller Army Community Hospital at West Point, the United States Military Academy: synovial sarcoma of the chest wall”. American Journal of Roentgenology 4 (2002): 880.
9. Mbatchou Ngahane BH., et al. “Évaluation des facteurs pronostiques du synovialosarcome thoracique”. Revue des Maladies Respiratoires 1 (2010): 93-97.
10. Bhattacharya D., et al. “Primary pulmonary synovial sarcoma: a case report and review of literature”. International Journal of Applied and Basic Medical Research 1 (2016): 63-65.
11. Thway K and Fisher C. “Synovial sarcoma: defining features and diagnostic evolution”. Annals of Diagnostic Pathology 6 (2014): 369-380.