A rare case of pleuropulmonary synovial sarcoma of the chest wall: A case report and a literature review

Pleuropulmonary synovial sarcoma is a subtype of synovial sarcomas that commonly arises from the chest wall, pleura, lungs and the heart. They are extremely rare, with only a few cases reported in the literature. It usually affects young and middle-aged adults with no gender predilection. Chest radiographs usually show a pleural-based mass, parenchymal consolidation, or a near complete opacification of the hemithorax. On contrast-enhanced CT, synovial sarcomas of the chest wall typically appear as a well-defined, heterogeneously enhancing mass with bone destruction and infiltration of chest wall musculature. MRI usually demonstrates a heterogeneous mass with areas of both high and low T1 signal intensities representing areas of hemorrhage and necrosis. We report a case of a 39- year old African male patient who presented to our hospital complaining of chest pain of 4 months duration. The plain chest radiograph showed complete opacification of the left hemithorax. Contrast-enhanced CT and MRI were then performed revealing a large left-sided heterogeneous mass. PET-CT demonstrated avid FDG uptake in the solid components of the mass with no evidence of distant metastasis.. An ultrasound-guided biopsy was performed, and histopathology revealed a locally advanced primary synovial sarcoma of the chest wall. Treatment consisted of neoadjuvant chemotherapy followed by surgical resection.