Pleural synovial sarcoma

Case contributed by Jayanth Keshavamurthy
Diagnosis certain


Shortness of breath and cough. Renal transplant and immuno suppression,

Patient Data

Age: 33
Gender: Female

Spot the abnormality.


Left supra hilar mass and left pleural effusion.


No contrast given.

Left pleural effusion with a left posterior supra hilar mass round, smooth borders, homogeneous density adjacent to left posterior pleura..

Right lung was normal.


4X and 20X H&E images of pleural synovial sarcoma. (A) Histologically, on the scanning power the lesion shows alveolar ling tissue with the sarcoma. (B) On higher power the lesion show highly cellular spindle cells areas that are densely packed into an interwoven herringbone pattern.

Immunohistochemical studies showed tumor cell nuclear immunoreactivity for TLE-1 and focal immunoreactivity for cytokeratin and calretinin. It is negative for HMB-45, TTF-1, myogenin, desmin, and S100. These immunohistologic and cytological findings are compatible with those found in synovial sarcoma according to current literature.

Case Discussion

Following biopsy and pathological confirmation of synovial sarcoma, she underwent left lung wedge resection and radiation therapy. She is doing well one year post-radiation. 

Studies in the last 10 years have shown that synovial sarcomas to be extremely sensitive to ifosfamide-based chemotherapy, with a 5-year survival rate of patients as high as 60%. 

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