Online Images in the Medical Sciences| Volume 365, ISSUE 3, e41-e42, March 2023

Download started.


Biphasic synovial sarcoma of the mediastinum with sternal invasion

Published:September 30, 2022DOI:
      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Paquette M
        • Truong PT
        • Hart J
        • et al.
        Primary sarcoma of the mediastinum: a report of 16 cases referred to the British Columbia Cancer Agency.
        J Thorac Oncol. 2010; 5: 898-906
        • Witkin GB
        • Miettinen M
        • Rosai J
        A biphasic tumor of the mediastinum with features of synovial sarcoma. A report of four cases.
        Am J Surg Pathol. 1989; 13: 490-499
        • Terra SBSP
        • Aesif SW
        • Maleszewski JJ
        • et al.
        Mediastinal synovial sarcoma: clinicopathologic analysis of 21 cases with molecular confirmation.
        Am J Surg Pathol. 2018; 42: 761-766