Pleuro-pulmonary synovial sarcoma
Citation, DOI and case data
Dry cough and shortness of breath for 1 month. Fever at times but no night sweats or TB contact. HIV negative.
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Right hemithorax white out with mass effect on the mediastinum. Also an infiltrative pattern of bone destruction involving the anterior right third rib.
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.
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.