An uncommon case of primary synovial sarcoma of the lung with a rare intraoperative finding

Abstract

We report a case of a 32-year-old male who was evaluated for right chest pain and cough with streaky hemoptysis. Chest X-ray and contrast-enhanced computerized tomography scan of the chest showed a large (20x16×16 cm), heterogeneously enhancing mass arising from the right lower lobe. Ultrasound-guided Tru-cut biopsy revealed spindle cell sarcoma. In immunohistochemistry, tumor cells expressed epithelial membrane antigen, CD99, and bcl-2. The final diagnosis of primary pulmonary synovial sarcoma was confirmed after positron emission tomography-computed tomography revealed that the lesion was confined to the right lung. The patient was managed by multimodal treatment. The patient underwent right anterolateral thoracotomy and lower lobectomy with staged systematic mediastinal lymphadenectomy. Intra-operatively, he was given 2 units of packed red blood cells (RBCs). The patient developed dark-colored urine near the end of the transfusion of the second unit of packed RBCs, but without any hemodynamic instability. All the tests for possible blood transfusion reactions were negative; thus, we concluded that this event was probably secondary to tumor lysis due to the handling of the large primary lesions during surgery.