Observation
We report the case of a 61-year-old patient, smoking 40 pack-year with a
history of ischemic heart disease and hypertension. The patient
consulted for a persistent right chest pain evolving for 3 months with
low abundance hemoptysis in a context of weight loss of 3-4 kg for 2
months, asthenia and anorexia. A series of explorations eliminated a
cardiac origin of the thoracic pain. Chest X- ray revealed a lung mass
measuring about 10 cm [Figure 1]. Chest CT confirmed the presence of
a large heterogeneous mass in the right upper lobar, massively necrotic,
adhering to the trachea, laminating the superior vena cava and pushing
the esophagus to the left, measuring 14 cm long [Figure 2] without
notable mediastinal, hilar, or axillary adenopathy, or adjacent bone
involvement. A CT-guided lung biopsy concluded that the pulmonary
synovialosarcoma was largely necrotic. In view of this histological
type, a meticulous clinical examination did not find a primary tumour,
particularly
in the soft tissues and in the periarticular area, so the primary
pulmonary origin was retained. The remote extension assessment was
negative. This case was discussed at a multidisciplinary concertation
meeting and the resectability of the tumour was rejected in view of the
locoregional extension and mediastinal invasion. The patient was
referred to the oncology department for radiochemotherapy.