Progressive Growth of Primary Synovial Sarcoma of the Lung

Jun Nakano, MD,1 Hiroyasu Yokomise, MD,1 Cheng-long Huang, MD,1 Noriyuki Misaki, MD,1 Sung-soo Chang, MD,1 Masaya Okuda, MD,1 Yoshio Kushida, MD,2 and Reiji Haba, MD2

An 80-year-old male was admitted because of a giant mass in the left lower lobe of the lung on a routine chest X-ray. Chest computed tomography verified this to be a well-defined heterogeneous mass as described with no associated lymphadenopathy. FDG-PET depicted moderately marginal FDG uptake. The patient underwent a left lower lobectomy and lymphadenectomy. Grossly, the tumor measured 60 × 50 mm and was uniformly filled with a pure white, pudding-like friable substance. No lymph node metastasis was observed microscopically. Histologically, the tumor showed a dense proliferation of rounded or spindled malignant cells with a frequent mitotic activity and an increased nuclear-to-cytoplasmic ratio. The immunohistochemical staining was positive for vimentin, negative for cytokeratin, keratin-wide, EMA, CD34. A SYT-SSX2 fusion gene transcript was detected as a result of RT-PCR analysis. Because of these results, the tumor was diagnosed as a monophasic synovial sarcoma. (Ann Thorac Cardiovasc Surg 2010; 16: 194-197)

Key words: synovial sarcoma, lung, operation, SYT-SSX

1Department of General Thoracic, Breast, and Endoclinological Surgery, Faculty of Medicine; and 2Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan

Received October 20, 2009; accepted for publication May 20, 2009
Address reprint requests to Jun Nakano, MD: Department of Thoracic Surgery, Faculty of Medicine, Kagawa University, 1750–1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761–0793, Japan.