The surprising outcome of a giant primary mediastinal synovial sarcoma treated with neoadjuvant chemotherapy.
There are only a few cases of primary mediastinal synovial sarcoma in the literature. Normally, they do not respond well to chemotherapy. In our case, a 30-year-old patient was admitted due to thoracic pain, dyspnea, orthopnea, cough, hoarseness and weight loss over a 3-month period as well as a dramatic worsening a week before the admission. A chest radiography showed a completely white left hemithorax and contralateral mediastinal shift; in addition, a chest tomography revealed a giant heterogeneous mediastinal mass, lung atelectasia and a small pleural effusion. The patient was submitted to Chamberlain procedure (biopsy) under local anesthesia and the diagnosis of a synovial sarcoma was obtained after immunohistochemical analysis. Due to his poor general condition, he received chemotherapy first, with a dramatic response, after what, the mass that had been reduced was removed surgically. After a 5-year- follow-up period there are no signs of disease recurrence.
Division of Thoracic Surgery, State University of Rio de Janeiro, Rio de Janeiro, Brazil;
Marcos Alexandre
MA
Balieiro
Agnaldo José
AJ
Lopes
Bruno Pinheiro
BP
Costa
Gustavo Perissé Moreira
GP
Veras
Paulo Sergio
PS
Perelson
Rodolfo
R
Acatauassú Nunes
Eduardo Haruo
EH
Saito
Sarcoma; adjuvant; chemotherapy; mediastinum; pleural effusion; synovial; thoracic surgery