Huge primary mediastinal synovial sarcoma fully occupying the right hemithorax.

Primary mediastinal synovial sarcomas are exceedingly uncommon tumors. Herein, we present the case of primary mediastinal synovial sarcoma (monophasic spindle cell-shaped variant) fully occupying the right hemithorax in a 37-year-old woman who presented to clinic with a 2-month history of right-sided chest pain and shortness of breath. Although extremely rare, however, synovial sarcoma should be considered in the differential diagnosis of all monophasic and biphasic spindle cell neoplasms of the mediastinum. Despite molecular testing for (t[x; 18] [p11.2; q11.2]) is characteristically positive in 90% of synovial sarcoma cases, it is not routinely done. Histopathological and immunohistochemical analyses can greatly confirm the diagnosis. Optimal surgical resection is the standard of care. Adjuvant therapy (radiotherapy and/or chemotherapy) is indicated in inoperable advanced disease or unachieved surgical tumor-free surgical margins. Prognosis is poor with a 5-year overall survival (OS) rate of 35.7%. Early diagnosis and prompt appropriate management yield better disease-free and OS rates.

Sterile Bronchopleural Fistula Following Surgical Removal of Primary Lung Leiomyoma Inducing Secondary Hypertrophic Osteoarthropathy.

BACKGROUND Leiomyomas are benign neoplasms of the smooth muscle. When found in the pulmonary system, a rare occurrence, leiomyomas can result in hypertrophic osteoarthropathy, or significant clubbing, associated with proliferation of long bone periosteum. Bronchopulmonary fistulas, or communications between the bronchial tree and pleural space, are an uncommon postoperative complication of pneumonectomies. Even more infrequent is the presence of a bronchopulmonary fistula that is determined to be sterile. CASE REPORT The patient presented in the current case report is a 40-year-old previously healthy woman who presented with a 5-year history of chronic cough, right-sided chest discomfort, and dyspnea associated with back pain, and lower leg pain. The CT scan performed on the patient revealed a mass originating from the right lower lobe. Activity at the site of the lesion, in the long bones of the upper and lower limbs, rib cage, and vertebral bones was demonstrated by a bone scan. A CT-guided biopsy was performed, and the pathology report confirmed the presence of a leiomyoma. Following a right-sided lobectomy, the resected tumor was sent for histopathology, with the results confirming the biopsy. The patient subsequently presented with a history of persistent cough associated with increased watery secretions. The CT scan revealed the presence of a bronchopleural fistula, after which the patient underwent surgical correction. All symptoms resolved, and the patient was discharged in stable condition. CONCLUSIONS Here, we report on a patient who presented with 3 rare clinical findings: pulmonary leiomyoma, hypertrophic osteoarthropathy, and sterile bronchopulmonary fistula.