Endobronchial primary synovial sarcoma is an extremely rare pulmonary tumor. We report the case of a 58-yearold man who presented with a right-sided endobronchial mass, which was diagnosed as primary synovial sarcoma on the basis of histological appearance and immunohistochemical staining. To the best of our knowledge, this is only the third case report of endobronchial primary synovial sarcoma.
The case
A 58-year-old man presented with a cough and a weight loss of about 10 lb in 3 months. His medical history was significant for pneumonia, which was treated with antibiotics, 3 months before presentation. He had a 40-pack-year history of smoking.
The initial physical examination showed the following: heart rate, 100 beats per minute; blood pressure, 108/65 mm Hg; oxygen saturation, 94% on room air (measured by pulse oximetry); and normal temperature. Chest auscultation revealed diminished breath sounds over the right hemithorax and bilateral expiratory wheeze. The patient's chest radiograph showed a right lower lobe infiltrate. A CT scan of the chest showed a right sided endobronchial mass and right lower lobe atelectasis (Figure 1). The patient was treated with intravenous piperacillin(Drug information on piperacillin)/tazobactam and inhaled bronchodilators.
Figure 1 – CT scan of the lungs shows an endobronchial mass (arrow) on the right side with right lower lobe atelectasis.
Flexible bronchoscopy showed an irregular, polypoidal, whitish mass occluding the bronchus intermedius (Figure 2). The pathology results were nonconclusive, and culture results were negative. Rigid bronchoscopy and a biopsy specimen of the mass showed spindle cells with scant dense stroma, suggesting synovial sarcoma.
Figure 2 – Flexible bronchoscopy shows an irregular, polypoidal, whitish mass occluding the bronchus intermedius. 