To report a case of primary pulmonary synovial sarcoma (PPSS) in a 60-year-old woman with an atypical presentation and highlight its aggressive clinical course despite multimodal therapy.
Approach:
Case Presentation: A 60-year-old woman with a significant smoking history presented with gross hematuria and was found to have a right lower lobe lung mass. Initial imaging and biopsy confirmed PPSS.
Treatment: The patient underwent neoadjuvant chemotherapy followed by surgical resection. Despite initial tumor reduction and negative margins, she experienced rapid metastatic progression.
Key Findings:
PPSS accounts for less than 0.5% of all primary lung malignancies and is characterized by a specific chromosomal translocation, t(X;18)(p11;q11).
The patient showed initial response to neoadjuvant chemotherapy but developed widespread metastases shortly after surgery.
Interpretation:
The case illustrates the aggressive nature of PPSS and the potential for rapid disease progression despite multimodal treatment.
Limitations:
The rarity of PPSS limits the generalizability of findings based on a single case report.
The case is based on a single patient experience.
Conclusion:
Recurrence and metastasis are common in PPSS even after apparent initial response to therapy, indicating a need for improved targeted therapies.
