Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1893-1900
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1893
Imaging findings of primary pulmonary synovial sarcoma with secondary distant metastases: A case report
Rui Li, Xin Teng, Wei-Hong Han, Yan Li, Qing-Wei Liu
Rui Li, Qing-Wei Liu, Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
Rui Li, Xin Teng, Wei-Hong Han, Department of Ultrasound, Qingdao Municipal Hospital, Shandong University, Qingdao 266000, Shandong Province, China
Yan Li, Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Qing-Wei Liu, Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Li R designed the report and wrote the paper; Han WH collected the patient’s medical imaging materials; Li Y participated in the revision of this article; Liu QW and Teng X designed the report and wrote the preliminary the paper.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Wei Liu, PhD, Chief Doctor, Professor, Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Lixia District, Jinan 250021, Shandong Province, China. lqwdsdu@outlook.com
Received: September 26, 2020
Peer-review started: September 26, 2020
First decision: December 28, 2020
Revised: January 8, 2021
Accepted: January 27, 2021
Article in press: January 27, 2021
Published online: March 16, 2021
Abstract
BACKGROUND

Synovial sarcoma (SS) accounting for 6%-10% of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs. Primary pulmonary SS (PPSS) is rare and has a poor prognosis. Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports. We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology, and shared valuable information on PPSS.

CASE SUMMARY

A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung. The results of a hemogram, erythrocyte sedimentation rate (ESR) and tumor markers were all within the normal range, tuberculin skin test (5 TU PPD) was negative (-). Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe. Thoracoscopic-assisted wedge resection of the right upper lobe of the lung, right upper lobe resection and lymph node dissection were performed. Nine months after surgery, ultrasound examination showed multiple metastases on the chest wall and kidney.

CONCLUSION

PPSS is a rare malignant lung tumor with strong invasiveness, early distant metastasis and poor prognosis. There are very few imaging reports. PPSS is often manifested as irregular tumor and calcification, and the metastases have extremely low echo on ultrasonography. Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement, manifested as “fast forward and fast regression”.

Keywords: Primary pulmonary synovial sarcoma, Imaging findings, Contrast-enhanced ultrasound, Secondary distant metastases, Computed tomography, Case report

Core Tip: A 43-year-old female patient was diagnosed with primary pulmonary synovial sarcoma (PPSS) and nine months later, metastases were found in the chest wall and both kidneys. There are very few imaging reports on PPSS. This study summarizes the imaging findings of PPSS and its secondary distant metastases. PPSS is often manifested as irregular tumor and calcification, and the metastases have extremely low echo on ultrasonography. Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement, manifested as “fast forward and fast regression”.