Spontaneous expectoration of primary pulmonary synovial sarcoma.

A-34-year-old Chinese man who had smoked about 20 cigarettes per day for the past 14 years presented with cough and hemoptysis that had persisted for 2 months. Chest radiography revealed mass shadow in the left lower field. A computed tomographic scan of the chest revealed the tumor in the left lower lobe, occupying left main bronchus lumen with polypoid endobronchial growth (Figure 1). Physical examination revealed wheezing in the left lung field. Routine laboratory investigations were within the normal limit. An abdominal–pelvic computed tomographic scan, bone scan, and Ga-67 citrate scintigraph were performed, and there was no evidence of diseases other than this lung mass. Bronchoscopy was performed, revealing a smooth, well-demarcated polypoid mass (Figure 2). The biopsy specimens only revealed necrotic tissue. Twelve days after the bronchoscopy, the patient expectorated a polypoid mass tissue with concurrent hemoptysis (Figure 3). Thoracotomy was performed for resection of the mass and lobectomy of the left lower lobe, and the patient was uneventful after the surgical resection. Macroscopically, a polypoid tumor arose from the left lower lobe, protruding into the left lower bronchus to the left primary bronchus. Microscopically, this tumor was suggestive of synovial sarcoma (Figure 4). Immunohistochemically, tumor cells were positive for vimentin and focally positive for pancytokeratin, recognized by AE1/AE3, cytokeratin 7, and