J Lung Cancer.  2008 Jun;7(1):29-33. 10.6058/jlc.2008.7.1.29.

Primary Mediastinal Synovial Sarcoma

Affiliations
  • 1Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea. chungjh@snu.ac.kr
  • 2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 3Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 5Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

We report a rare case of a primary mediastinal synovial sarcoma. A 44-year-old man had a well-defined tumor in the left posterior mediastinum involving the left lower lobe of the lung, as detected on chest computed tomography, and underwent an en bloc excision and a left lower lobectomy. Grossly, the tumor measured 8.0 cm in the greatest diameter, with a solid and tan-white cut surface. Histologically, the tumor was mainly composed of spindle-shaped cells with a few foci of epithelial differentiation. Immunohistochemical studies were focally positive for cytokeratin, and diffusely positive for vimentin and bcl-2. Epithelial membrane antigen, S-100 protein, desmin, smooth muscle actin, calretinin, and CD34 were all negative. The SYT-SSX1 gene fusion transcript was detected by a reverse transcription- polymerase chain reaction, which was diagnostic of primary synovial sarcoma of the mediastinum. We also reviewed the literature with regard to the clinicopathologic, immunohistochemical, and molecular studies of primary intrathoracic synovial sarcoma

Keyword

Synovial sarcoma; Mediastinum

MeSH Terms

Actins
Adult
Calcium-Binding Protein, Vitamin D-Dependent
Desmin
Gene Fusion
Humans
Keratins
Lung
Mediastinum
Mucin-1
Muscle, Smooth
Oncogene Proteins, Fusion
Polymerase Chain Reaction
S100 Proteins
Sarcoma, Synovial
Thorax
Vimentin
Actins
Calcium-Binding Protein, Vitamin D-Dependent
Desmin
Keratins
Mucin-1
Oncogene Proteins, Fusion
S100 Proteins
Vimentin

Figure

  • Fig. 1. Computed tomography (CT) images showed a soft tissue mass in the left posterior mediastinum.

  • Fig. 2. Gross photograph of the resected synovial sarcoma. The mass was relatively well-demarcated and showed expansile growth to the lung.

  • Fig. 3. Histologic features of synovial sarcoma; most areas consisted of monophasic fibrous type (x200) (A), A transition between pale staining epithelial and dark staining spindle cells is identified (x100) (B).

  • Fig. 4. Immunohistochemical findings; focal positivity for cytokeratin in the vaguely epithelial area (x400) (A), and diffuse positivity for bcl-2 (x400) (B).

  • Fig. 5. The result of RT-PCR for the SYT-SSX1 fusion transcript in the resected tumor cells was positive. Sample 1: PC (positive control), 2: NC (negative control), 3, 4, 5: this case.


Reference

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