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A Pulmonary Zebra: Adult Primary Pulmonary Synovial Sarcoma

A Pulmonary Zebra: Adult Primary Pulmonary Synovial Sarcoma Hindawi Case Reports in Oncological Medicine Volume 2022, Article ID 8649540, 3 pages https://doi.org/10.1155/2022/8649540 Case Report Sheffield Sandra , Nwachukwu Chidi, and Ashby Tracy Department of Medicine, UF College of Medicine – Jacksonville, 653-1 West 8th Street, L20 4th Floor, LRC Jacksonville, FL 32209, USA Correspondence should be addressed to Sheffield Sandra; sandrash@pcom.edu Received 3 September 2021; Revised 29 March 2022; Accepted 4 April 2022; Published 16 April 2022 Academic Editor: Ossama W. Tawfik Copyright © 2022 Sheffield Sandra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Primary pulmonary synovial sarcoma (PPSS) is an extremely rare tumor, with approximately 50 cases being reported in the English literature (Golota et al., 2018). Difficulties are often encountered in the diagnosis of PPSS as it can be confused with other spindle or round cell tumors, such as fibrosarcoma, hemangiopericytoma, mesothelioma, sarcomatoid carcinoma, or metastatic sarcomas. PPSS was first described by Zeren et al. in 1995. We present a case of PPSS in a 41-year-old woman, who complained of progressive dyspnea and left-sided chest pain. 1. Introduction with a recurrent reciprocal translocation between chromo- somes X and 18, t(X; 18) (p11.2; q11.2), which leads to the Sarcomas are a diverse group of malignant tumors. Sarco- expression of several different SS18:SSX fusion proteins. mas predominantly arise from the embryonic mesoderm The fusion proteins SYT-SSX1 and SYT-SSX2 are believed [1]. More than 100 sarcoma subtypes have been identified to function as aberrant transcriptional regulators, resulting with distinctive pathology, molecular characteristics, and in either activation of protooncogenes or inhibition of tumor clinical presentations. Sarcomas represent <1% of adult can- suppressor genes [4]. cers and account for approximately 21% of pediatric malig- Primary SS is most common in the large joint of the nancies [2]. There are two main categories of sarcomas: (1) extremities. However, primary SS have been documented tumors arising from the soft tissues (e.g., muscle, tendons, in most human tissues and organs including the neck, brain, and blood vessels) and (2) those arising from the bone prostate, tongue, kidney, larynx, mediastinum, esophagus, (e.g., osteosarcoma and Ewing’s sarcoma). Approximately heart, abdomen wall, small intestine, mesentery, vessels, ret- 80% arise from soft tissue and 20% originate from the bone. roperitoneum, and lungs [5]. PPSS can originate from ves- The World Health Organization has defined approximately sels, pulmonary stroma, and mesenchymal elements of the 50 soft tissue sarcoma histologic subtypes [1]. Soft tissue sar- bronchial wall. PPSS accounts for 0.1% to 0.5% of all pri- comas include angiosarcoma, liposarcoma, leiomyosarcoma, mary lung malignancies [6]. Most of the available literature neurofibrosarcoma, schwannoma, Kaposi’s sarcoma, rhab- concerning PPSS is limited to case reports and case series [7]. domyosarcoma, vascular sarcoma, fibrosarcoma, mesenchy- momas, myxofibrosarcoma, gastrointestinal stromal tumor, and synovial sarcomas. 2. Case Report Synovial sarcomas (SS) are one of the most common soft tissue tumors in adolescents and young adults, and it A 41-year-old female of Indian descent with no significant accounts for approximately 5–10% of all soft tissue sarcomas past medical history presented to the emergency room with [3]. About one-third of cases occur in the first two decades a 2-month history of progressive dyspnea on exertion and of life with an average age of 30 years at diagnosis. The ori- sharp, pleuritic, substernal chest pain. She also endorsed gin of synovial sarcoma is unclear. However, SS is associated anxiety and chest palpitations, denied edema, nausea, 2 Case Reports in Oncological Medicine ment on the left supraclavicular and infraclavicular areas. There was no cervical lymphadenopathy or clubbing. Initial blood gas analysis was pH 7.2/CO2 47.9/HCO3 28/PO2 of 70. An electrocardiogram revealed sinus tachy- cardia. Cardiac biomarkers were negative. Complete hemo- gram revealed normocytic anemia with a hemoglobin level of 11.5 g/dl (reference [8]-16 g/dl), and a complete metabolic panel revealed a bicarb level of 35 (reference 21-29 mmol/l). A chest radiograph revealed opacification of the left hemi- thorax with a mass effect on the mediastinal structures. A chest computer tomography (CT) revealed a large mixed attenuated mass involving the left chest and mediastinum Figure 1: CT axial view arterial phase postcontrast large 17:9× measuring 17:9×17:6×18:3 cm in dimension (Figures 1, 17:6×18:3 cm heterogeneous mass centered within the left 2, and 3). Furthermore, a video-assisted thoracoscopic hemithorax, resulting in rightward mediastinal shift. An biopsy from the lung mass showed an infiltrating spindle cell incidental right pleural effusion is present. neoplasm. The immunohistochemistry of the tissue sample revealed cells expressing epithelial membrane antigen (EMA), CD99, BCL-2, and calponin. The cells were immune-negative for cytokeratin and S-100. 3. Case Discussion PPSS is a rare and highly aggressive type of SS, usually occurring in young adults. It generally presents as a large, circumscribed mass. Metastatic SS from extremities is com- mon in the pulmonary parenchyma and pleura. Patients with PPSS often present with chest wall pain, cough, dys- pnea, hemoptysis, and ipsilateral pleural effusions. There may be a slight male predilection, but there is no relation to smoking status [9]. Toxic substances and radiation have Figure 2: CT chest coronal MIP (maximum intensity projection) been noted as risks factors. Furthermore, reciprocal translo- rightward mediastinal shift and partial right lung collapse cations between chromosomes X and 18 and infectious path- secondary to left hemithoracic mass effect. ogens have been noted to have an impact on the origin of PPSS. The diagnosis of PPSS requires clinical, pathological, and immunohistochemical investigations and radiological find- ings to exclude alternative primary lung tumors and metas- tatic sarcomas [9, 10]. Primary pulmonary synovial sarcomas are composed of two morphologically different cell types: (1) epithelial cells or (2) fibroblast-like spindle cells [11]. Histopathologically, there are four subtypes of PPSS, monophasic fibrous cell and biphasic; less common subtypes include monophasic epithelial and poorly differentiated (round cell) tumors [12]. Immunohistochemically, PPSS is positive for markers such as CD99, Bcl-2, vimentin, desmin, actin, cytokeratin, and EMA [2]. Based on radiologic imag- ing alone, manifestations of PPSS are indistinguishable from other common pulmonary and pleural neoplasms [6]. Typi- Figure 3: CT sagittal projection centered along the midline cal CT imaging findings are large, heterogeneous tumors depicted anterior displacement of mediastinal structures with internal necrosis. Radiologic findings are useful for secondary to larger left hemithoracic mass, which crosses the delineating the extent of tumor involvement, determining midline. the potential for surgical resection, and monitoring the effects of chemotherapy or radiation therapy. Our case was vomiting, fevers, and chills, and has no history of tobacco, characterized by a well-defined heterogeneous enhancing alcohol, or illicit drug use. mass of the left hemithorax with the presence of spindle cell On physical examination, vital signs revealed a heart rate sarcoma on histopathological examination and the expres- of 126 beats per minute and a respiratory rate of 32 breaths sion of positive tumor markers for EMA, CD99, BCL-2, per minute. She was pale with decreased respiratory move- and calponin. Case Reports in Oncological Medicine 3 [4] N. Naka, S. Takenaka, N. Araki et al., “Synovial sarcoma is a Currently, there is no standardized therapy for patients stem cell malignancy,” Stem Cells, vol. 28, no. 7, pp. 1119– with PPSS. Treatment options include surgery, chemother- 1131, 2010. apy, radiation, and recently adoptive immunotherapy using [5] H. Zeren, C. A. Moran, S. Suster, N. F. Fishback, and M. N. tumor-infiltrating lymphocytes [13]. The preferred modality Koss, “Primary pulmonary sarcomas with features of mono- of treatment for PPSS is complete surgical resection. The phasic synovial sarcoma: a clinicopathological, immunohisto- standard surgical strategy of PPSS includes lobectomy and chemical, and ultrastructural study of 25 cases,” Human pneumonectomy. According to Golota et al., the treatment Pathology, vol. 26, no. 5, pp. 474–480, 1995. of choice for PPSS is anatomical resection of lung tissue with [6] G. H. Kim, M. Y. Kim, H. J. Koo, J. S. Song, and C.-M. Choi, a tumor-free margin. Male patients and those with tumors “Primary pulmonary synovial sarcoma in a tertiary referral larger than 5 cm have worse prognoses. Golota et al. also center: clinical characteristics, CT, and 18F-FDG PET find- reported higher overall survival in patients who underwent ings, with pathologic correlations,” Medicine, vol. 94, no. 34, nonanatomical resections versus those who underwent ana- p. e1392, 2015. tomical resections. [7] D. J. Boulter, M. L. Rosado-de-Christenson, R. Stevens, and For unresectable tumors, chemotherapy, radiotherapy, S. Suster, “Primary synovial sarcoma of the lung,” Radiology and immunotherapy can be considered [3, 6, 12]. PPSS is Case Reports, vol. 2, no. 4, p. 82, 2007. considered relatively chemosensitive to chemotherapy [8] P. Robbins, R. A. Morgan, S. A. Feldman et al., “Tumor regres- agents such as ifosfamide, doxorubicin, and dacarbazine sion in patients with metastatic synovial cell sarcoma and mel- [14]. Robbins et al. tested the effectiveness of adoptive anoma using genetically engineered lymphocytes reactive with immunotherapy with genetically engineered lymphocytes NY-ESO-1,” Journal OF Clinical Oncology, vol. 29, no. 7, that targeted the NY-ESO-1 antigen expressed in patients pp. 917–924, 2011. with advance synovial cell sarcomas, demonstrating that [9] A. Das, A. Sarkar, A. K. Dwari, S. Datta, and P. P. Roy, “A pri- treatment with engineered lymphocytes mediates tumor mary synovial sarcoma of lung,” North American Journal of regression in patients with metastatic synovial cell sarcomas Medical Sciences, vol. 4, no. 5, pp. 241–243, 2012. [13]. The overall survival of patients with PPSS is poor, with [10] P. H. Hartel, J. C. Fanburg-Smith, A. A. Frazier et al., “Primary a 5-year survival rate of 50%. Future studies are needed to pulmonary and mediastinal synovial sarcoma: a clinicopatho- identify ideal therapeutic agents for the treatment of PPSS. logic study of 60 cases and comparison with five prior series,” Modern Pathology, vol. 20, no. 7, pp. 760–769, 2007. [11] D. Bhattacharya, S. Datta, A. Das, K. C. Halder, and 4. Conclusion S. Chattopadhyay, “Primary pulmonary synovial sarcoma: a case report and review of literature,” International Journal of PPSS is a very rare and aggressive tumor that should be Applied and Basic Medical Research, vol. 6, no. 1, pp. 63–65, included on the differential for lung and pleural masses. Due to poor prognosis, prompt diagnosis and treatment is [12] S. Okamoto, M. Hisaoka, T. Daa, K. Hatakeyama, T. Iwamasa, imperative. and H. Hashimoto, “Primary pulmonary synovial sarcoma: a clinicopathologic, immunohistochemical, and molecular study of 11 cases,” Human Pathology, vol. 35, no. 7, pp. 850–856, Data Availability The CT images used to support the findings noted on this [13] L. Rajeev, R. Patidar, G. Babu, M. C. Suresh Babu, K. N. case report were collected during the patient hospitalization. Lokesh, and G. V. Patil Okaly, “A rare case of primary synovial The data presented on this study have not been made avail- sarcoma of lung,” Lung India, vol. 34, no. 6, p. 545, 2017. able because the patient is deceased. [14] M. Panigrahi, G. Pradhan, N. Sahoo, P. Mishra, S. Patra, and P. R. Mohapatra, “Primary pulmonary synovial sarcoma: a reappraisal,” Journal of Cancer Research and Therapies, Conflicts of Interest vol. 14, no. 3, pp. 481–489, 2018. The authors declare that they have no conflicts of interest. References [1] L. Guy, A. Lazar, and D. Lev, “Sarcoma epidemiology and eti- ology: potential environmental and genetic factors,” Surgical Clinics of North America, vol. 88, no. 3, p. 451, 2008. [2] B. Jenna, R. D. Ballim, S. Kimani et al., “Managing sarcoma: where have we come from and where are we going,” Therapeu- tic Advances in Medical Oncology, vol. 9, no. 10, pp. 637–659, [3] J. Golota, K. Osowiecka, and T. Orłowski, “Primary pulmo- nary sarcoma - long-term treatment outcomes and prognostic factors,” Polish Journal of Cardio-Thoracic Surgery, vol. 15, no. 3, pp. 162–169, 2018. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

A Pulmonary Zebra: Adult Primary Pulmonary Synovial Sarcoma

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Copyright © 2022 Sheffield Sandra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2022, Article ID 8649540, 3 pages https://doi.org/10.1155/2022/8649540 Case Report Sheffield Sandra , Nwachukwu Chidi, and Ashby Tracy Department of Medicine, UF College of Medicine – Jacksonville, 653-1 West 8th Street, L20 4th Floor, LRC Jacksonville, FL 32209, USA Correspondence should be addressed to Sheffield Sandra; sandrash@pcom.edu Received 3 September 2021; Revised 29 March 2022; Accepted 4 April 2022; Published 16 April 2022 Academic Editor: Ossama W. Tawfik Copyright © 2022 Sheffield Sandra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Primary pulmonary synovial sarcoma (PPSS) is an extremely rare tumor, with approximately 50 cases being reported in the English literature (Golota et al., 2018). Difficulties are often encountered in the diagnosis of PPSS as it can be confused with other spindle or round cell tumors, such as fibrosarcoma, hemangiopericytoma, mesothelioma, sarcomatoid carcinoma, or metastatic sarcomas. PPSS was first described by Zeren et al. in 1995. We present a case of PPSS in a 41-year-old woman, who complained of progressive dyspnea and left-sided chest pain. 1. Introduction with a recurrent reciprocal translocation between chromo- somes X and 18, t(X; 18) (p11.2; q11.2), which leads to the Sarcomas are a diverse group of malignant tumors. Sarco- expression of several different SS18:SSX fusion proteins. mas predominantly arise from the embryonic mesoderm The fusion proteins SYT-SSX1 and SYT-SSX2 are believed [1]. More than 100 sarcoma subtypes have been identified to function as aberrant transcriptional regulators, resulting with distinctive pathology, molecular characteristics, and in either activation of protooncogenes or inhibition of tumor clinical presentations. Sarcomas represent <1% of adult can- suppressor genes [4]. cers and account for approximately 21% of pediatric malig- Primary SS is most common in the large joint of the nancies [2]. There are two main categories of sarcomas: (1) extremities. However, primary SS have been documented tumors arising from the soft tissues (e.g., muscle, tendons, in most human tissues and organs including the neck, brain, and blood vessels) and (2) those arising from the bone prostate, tongue, kidney, larynx, mediastinum, esophagus, (e.g., osteosarcoma and Ewing’s sarcoma). Approximately heart, abdomen wall, small intestine, mesentery, vessels, ret- 80% arise from soft tissue and 20% originate from the bone. roperitoneum, and lungs [5]. PPSS can originate from ves- The World Health Organization has defined approximately sels, pulmonary stroma, and mesenchymal elements of the 50 soft tissue sarcoma histologic subtypes [1]. Soft tissue sar- bronchial wall. PPSS accounts for 0.1% to 0.5% of all pri- comas include angiosarcoma, liposarcoma, leiomyosarcoma, mary lung malignancies [6]. Most of the available literature neurofibrosarcoma, schwannoma, Kaposi’s sarcoma, rhab- concerning PPSS is limited to case reports and case series [7]. domyosarcoma, vascular sarcoma, fibrosarcoma, mesenchy- momas, myxofibrosarcoma, gastrointestinal stromal tumor, and synovial sarcomas. 2. Case Report Synovial sarcomas (SS) are one of the most common soft tissue tumors in adolescents and young adults, and it A 41-year-old female of Indian descent with no significant accounts for approximately 5–10% of all soft tissue sarcomas past medical history presented to the emergency room with [3]. About one-third of cases occur in the first two decades a 2-month history of progressive dyspnea on exertion and of life with an average age of 30 years at diagnosis. The ori- sharp, pleuritic, substernal chest pain. She also endorsed gin of synovial sarcoma is unclear. However, SS is associated anxiety and chest palpitations, denied edema, nausea, 2 Case Reports in Oncological Medicine ment on the left supraclavicular and infraclavicular areas. There was no cervical lymphadenopathy or clubbing. Initial blood gas analysis was pH 7.2/CO2 47.9/HCO3 28/PO2 of 70. An electrocardiogram revealed sinus tachy- cardia. Cardiac biomarkers were negative. Complete hemo- gram revealed normocytic anemia with a hemoglobin level of 11.5 g/dl (reference [8]-16 g/dl), and a complete metabolic panel revealed a bicarb level of 35 (reference 21-29 mmol/l). A chest radiograph revealed opacification of the left hemi- thorax with a mass effect on the mediastinal structures. A chest computer tomography (CT) revealed a large mixed attenuated mass involving the left chest and mediastinum Figure 1: CT axial view arterial phase postcontrast large 17:9× measuring 17:9×17:6×18:3 cm in dimension (Figures 1, 17:6×18:3 cm heterogeneous mass centered within the left 2, and 3). Furthermore, a video-assisted thoracoscopic hemithorax, resulting in rightward mediastinal shift. An biopsy from the lung mass showed an infiltrating spindle cell incidental right pleural effusion is present. neoplasm. The immunohistochemistry of the tissue sample revealed cells expressing epithelial membrane antigen (EMA), CD99, BCL-2, and calponin. The cells were immune-negative for cytokeratin and S-100. 3. Case Discussion PPSS is a rare and highly aggressive type of SS, usually occurring in young adults. It generally presents as a large, circumscribed mass. Metastatic SS from extremities is com- mon in the pulmonary parenchyma and pleura. Patients with PPSS often present with chest wall pain, cough, dys- pnea, hemoptysis, and ipsilateral pleural effusions. There may be a slight male predilection, but there is no relation to smoking status [9]. Toxic substances and radiation have Figure 2: CT chest coronal MIP (maximum intensity projection) been noted as risks factors. Furthermore, reciprocal translo- rightward mediastinal shift and partial right lung collapse cations between chromosomes X and 18 and infectious path- secondary to left hemithoracic mass effect. ogens have been noted to have an impact on the origin of PPSS. The diagnosis of PPSS requires clinical, pathological, and immunohistochemical investigations and radiological find- ings to exclude alternative primary lung tumors and metas- tatic sarcomas [9, 10]. Primary pulmonary synovial sarcomas are composed of two morphologically different cell types: (1) epithelial cells or (2) fibroblast-like spindle cells [11]. Histopathologically, there are four subtypes of PPSS, monophasic fibrous cell and biphasic; less common subtypes include monophasic epithelial and poorly differentiated (round cell) tumors [12]. Immunohistochemically, PPSS is positive for markers such as CD99, Bcl-2, vimentin, desmin, actin, cytokeratin, and EMA [2]. Based on radiologic imag- ing alone, manifestations of PPSS are indistinguishable from other common pulmonary and pleural neoplasms [6]. Typi- Figure 3: CT sagittal projection centered along the midline cal CT imaging findings are large, heterogeneous tumors depicted anterior displacement of mediastinal structures with internal necrosis. Radiologic findings are useful for secondary to larger left hemithoracic mass, which crosses the delineating the extent of tumor involvement, determining midline. the potential for surgical resection, and monitoring the effects of chemotherapy or radiation therapy. Our case was vomiting, fevers, and chills, and has no history of tobacco, characterized by a well-defined heterogeneous enhancing alcohol, or illicit drug use. mass of the left hemithorax with the presence of spindle cell On physical examination, vital signs revealed a heart rate sarcoma on histopathological examination and the expres- of 126 beats per minute and a respiratory rate of 32 breaths sion of positive tumor markers for EMA, CD99, BCL-2, per minute. She was pale with decreased respiratory move- and calponin. Case Reports in Oncological Medicine 3 [4] N. Naka, S. Takenaka, N. Araki et al., “Synovial sarcoma is a Currently, there is no standardized therapy for patients stem cell malignancy,” Stem Cells, vol. 28, no. 7, pp. 1119– with PPSS. Treatment options include surgery, chemother- 1131, 2010. apy, radiation, and recently adoptive immunotherapy using [5] H. Zeren, C. A. Moran, S. Suster, N. F. Fishback, and M. N. tumor-infiltrating lymphocytes [13]. The preferred modality Koss, “Primary pulmonary sarcomas with features of mono- of treatment for PPSS is complete surgical resection. The phasic synovial sarcoma: a clinicopathological, immunohisto- standard surgical strategy of PPSS includes lobectomy and chemical, and ultrastructural study of 25 cases,” Human pneumonectomy. According to Golota et al., the treatment Pathology, vol. 26, no. 5, pp. 474–480, 1995. of choice for PPSS is anatomical resection of lung tissue with [6] G. H. Kim, M. Y. Kim, H. J. Koo, J. S. Song, and C.-M. Choi, a tumor-free margin. Male patients and those with tumors “Primary pulmonary synovial sarcoma in a tertiary referral larger than 5 cm have worse prognoses. Golota et al. also center: clinical characteristics, CT, and 18F-FDG PET find- reported higher overall survival in patients who underwent ings, with pathologic correlations,” Medicine, vol. 94, no. 34, nonanatomical resections versus those who underwent ana- p. e1392, 2015. tomical resections. [7] D. J. Boulter, M. L. Rosado-de-Christenson, R. Stevens, and For unresectable tumors, chemotherapy, radiotherapy, S. Suster, “Primary synovial sarcoma of the lung,” Radiology and immunotherapy can be considered [3, 6, 12]. PPSS is Case Reports, vol. 2, no. 4, p. 82, 2007. considered relatively chemosensitive to chemotherapy [8] P. Robbins, R. A. Morgan, S. A. Feldman et al., “Tumor regres- agents such as ifosfamide, doxorubicin, and dacarbazine sion in patients with metastatic synovial cell sarcoma and mel- [14]. Robbins et al. tested the effectiveness of adoptive anoma using genetically engineered lymphocytes reactive with immunotherapy with genetically engineered lymphocytes NY-ESO-1,” Journal OF Clinical Oncology, vol. 29, no. 7, that targeted the NY-ESO-1 antigen expressed in patients pp. 917–924, 2011. with advance synovial cell sarcomas, demonstrating that [9] A. Das, A. Sarkar, A. K. Dwari, S. Datta, and P. P. Roy, “A pri- treatment with engineered lymphocytes mediates tumor mary synovial sarcoma of lung,” North American Journal of regression in patients with metastatic synovial cell sarcomas Medical Sciences, vol. 4, no. 5, pp. 241–243, 2012. [13]. The overall survival of patients with PPSS is poor, with [10] P. H. Hartel, J. C. Fanburg-Smith, A. A. Frazier et al., “Primary a 5-year survival rate of 50%. Future studies are needed to pulmonary and mediastinal synovial sarcoma: a clinicopatho- identify ideal therapeutic agents for the treatment of PPSS. logic study of 60 cases and comparison with five prior series,” Modern Pathology, vol. 20, no. 7, pp. 760–769, 2007. [11] D. Bhattacharya, S. Datta, A. Das, K. C. Halder, and 4. Conclusion S. Chattopadhyay, “Primary pulmonary synovial sarcoma: a case report and review of literature,” International Journal of PPSS is a very rare and aggressive tumor that should be Applied and Basic Medical Research, vol. 6, no. 1, pp. 63–65, included on the differential for lung and pleural masses. Due to poor prognosis, prompt diagnosis and treatment is [12] S. Okamoto, M. Hisaoka, T. Daa, K. Hatakeyama, T. Iwamasa, imperative. and H. Hashimoto, “Primary pulmonary synovial sarcoma: a clinicopathologic, immunohistochemical, and molecular study of 11 cases,” Human Pathology, vol. 35, no. 7, pp. 850–856, Data Availability The CT images used to support the findings noted on this [13] L. Rajeev, R. Patidar, G. Babu, M. C. Suresh Babu, K. N. case report were collected during the patient hospitalization. Lokesh, and G. V. Patil Okaly, “A rare case of primary synovial The data presented on this study have not been made avail- sarcoma of lung,” Lung India, vol. 34, no. 6, p. 545, 2017. able because the patient is deceased. [14] M. Panigrahi, G. Pradhan, N. Sahoo, P. Mishra, S. Patra, and P. R. Mohapatra, “Primary pulmonary synovial sarcoma: a reappraisal,” Journal of Cancer Research and Therapies, Conflicts of Interest vol. 14, no. 3, pp. 481–489, 2018. The authors declare that they have no conflicts of interest. References [1] L. Guy, A. Lazar, and D. Lev, “Sarcoma epidemiology and eti- ology: potential environmental and genetic factors,” Surgical Clinics of North America, vol. 88, no. 3, p. 451, 2008. [2] B. Jenna, R. D. Ballim, S. Kimani et al., “Managing sarcoma: where have we come from and where are we going,” Therapeu- tic Advances in Medical Oncology, vol. 9, no. 10, pp. 637–659, [3] J. Golota, K. Osowiecka, and T. Orłowski, “Primary pulmo- nary sarcoma - long-term treatment outcomes and prognostic factors,” Polish Journal of Cardio-Thoracic Surgery, vol. 15, no. 3, pp. 162–169, 2018.

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Published: Apr 16, 2022

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