Presentation
Dry cough and shortness of breath for 1 month. Fever at times but no night sweats or TB contact. HIV negative.
Patient Data
Right hemithorax white out with mass effect on the mediastinum. Also an infiltrative pattern of bone destruction involving the anterior right third rib.
Case Discussion
The differential for white out of a hemithorax with mass effect, would include pleural effusion and complete lung collapse, large pulmonary mass or diaphragmatic hernia/rupture. An ultrasound can help, especially with an effusion.
The rib destruction would point to a mass, with Ewing's or synovial sarcoma likely.
Ultrasound in this case demonstrated a large mass with no pleural fluid. Biopsy of the mass was performed.
Histology report
There are small fragments of a variably cellular spindle cell neoplasm, composed of plump spindle-shaped cells with occasional mitotic figures. No necrosis is identified in this specimen.
Immunocytochemical studies show tumor cells are positive for vimentin and bcl2, and are negative for pan-CK (AE1/AE3), CD34, CD99, S100, actin and desmin.
The morphology is most consistent with a synovial sarcoma.
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