Primary Mediastinal Synovial Sarcoma

Hyun Ju Lee; Jin-Haeng Chung; Joon Sung Joh; Jae-Ho Lee; Tae Jeong Kim; Sanghoon Jheon; Soo-Mee Bang; Jae-Sung Kim

doi:10.6058/jlc.2008.7.1.29

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Lee, Chung, Joh, Lee, Kim, Jheon, Bang, and Kim: Primary Mediastinal Synovial Sarcoma

Original Article

J Lung Cancer 2008;7(1):29-33.

Published online: 10 January 2008

DOI: https://doi.org/10.6058/jlc.2008.7.1.29

Primary Mediastinal Synovial Sarcoma

Hyun Ju Lee, M.D.¹, Jin-Haeng Chung, M.D.¹, Joon Sung Joh, M.D.², Jae-Ho Lee, M.D.², Tae Jeong Kim, M.D.³, Sanghoon Jheon, M.D.⁴, Soo-Mee Bang, M.D.², Jae-Sung Kim, M.D.⁵

¹Departments of Pathology

²Internal Medicine

³Radiology

⁴Thoracic Surgery

⁵Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea

Address for correspondence Jin-Haeng Chung, M.D. Department of Pathology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam 463-707, Korea. Tel: 82-31-787-7713 Fax: 82-31-787-4012 E-mail: chungjh@snu.ac.kr

Received 14 May 2008 Accepted 28 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Synovial sarcoma, Mediastinum

References

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Figures

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.

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