PRIMARY INTRATHORACIC SYNOVIAL SARCOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Synovial sarcomas (SS) are a rare group of malignancies, seen in 0.17 per 100,000 persons, accounting for 7% all soft tissue sarcomas. These malignant tumors most commonly present as tumor the extremities. While they have high propensity metastasis to bone and lung, primary intrathoracic malignancy is rare. We case patient who presented with acute onset shortness breath, diagnosed synovial sarcoma lung. CASE PRESENTATION: A 22-year-old male no past significant medical history four-week right upper quadrant abdominal pain chest radiating his shoulder associated dyspnea. On arrival emergency department, was tachycardia, otherwise vitally stable. Labs were notable leukocytosis. Chest x-ray showed moderate right-sided pleural effusion opacity lower hemithorax. tube placed however fluid evacuated. CT obtained which lobe hemithorax, pleural-based nodule measuring 2x2 x 1.6 cm, lesion within hemithorax 20x17.9x19.3 cm. The taken video-assisted thoracoscopic surgery surgical exploration placement. Patient found large invading whole compression on mediastinal structures including heart, IVC. Biopsies taken. developed respiratory distress obstructive shock intubated vasopressor support. Preliminary pathology revealing sarcoma. Operative findings revealed posterior mass through diaphragm into peritoneal space liver capsule. He underwent thoracotomy excision resection thoracoabdominal tumor, total pulmonary decortication, wedge middle lobe, reconstruction diaphragm. successfully extubated three days post operatively soon after discharged home. Post-operative definite evidence gross residual disease. received 3 cycles doxorubicin/isofosfamide following discharge. DISCUSSION: thoracic SS Diagnosis often delayed because benign radiographic appearance indolent nature these tumors; sequelae disease do not manifest until burden great enough cause effect. Though standard care chemotherapy, this required palliative due cardiovascular compromise. CONCLUSIONS: account less than 0.1% neoplasms, it should be considered differential malignancies delay diagnosis could consequential outcome. REFERENCE #1: Javad Parvizi, Gregory K. Kim, Chapter 218 - Sarcoma, Editor(s): High Yield Orthopaedics, W.B. Saunders, 2010, Pages 455-456, ISBN 9781416002369, https://doi.org/10.1016/B978-1-4160-0236-9.00230-3. #2: Nedra Joseph, Samantha St. Laurent, Jeanenne Joy Nelson, Shan Zheng, Heide Stirnadel-Farrant. Journal Clinical Oncology 2019 37:15_suppl, e22535-e22535 DISCLOSURES: No relevant relationships by Neiha Kidwai, source=Web Response