A 24-year-old woman presented with cough and dyspnea without obvious inducement over
10 days. Here body weight decreased by approximately 1 kg since the onset of the disease.
The chest computed tomography revealed a large soft tissue density mass lesion located
in the superior mediastinum with heterogeneous enhancement (Figure 1A-C) and sternal invasion (Figure 1D, arrow). Mild pericardial and pleural effusion with pericardial thickening was noted
(Figure 2A-B, arrow). There was no evidence of synovial tissue involvement outside the thorax.
CT-guided percutaneous biopsy revealed the mass as a spindle cell variant of adenocarcinoma.
Immunohistochemistry of the biopsied sample showed cytokeratin 7 (CK7) (+), vimentin
(Vim) (+) (Figure 3A-B), and epithelial membrane antigen (EMA) (+). A biphasic type of tumor consists
of distinct epithelial and spindle cell components. Both epithelial and spindle cells
are reactive to CK and EMA, whereas only the spindle cells are positive for Vim. Finally,
a diagnosis of biphasic synovial sarcoma with a spindle cell component and an epithelial
component of the mediastinum was confirmed.
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References
- Primary sarcoma of the mediastinum: a report of 16 cases referred to the British Columbia Cancer Agency.J Thorac Oncol. 2010; 5: 898-906
- A biphasic tumor of the mediastinum with features of synovial sarcoma. A report of four cases.Am J Surg Pathol. 1989; 13: 490-499
- Mediastinal synovial sarcoma: clinicopathologic analysis of 21 cases with molecular confirmation.Am J Surg Pathol. 2018; 42: 761-766
Article info
Publication history
Published online: September 30, 2022
Accepted:
September 20,
2022
Received:
January 9,
2022
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
