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Biphasic synovial sarcoma of the mediastinum with sternal invasion

Published:September 30, 2022DOI:https://doi.org/10.1016/j.amjms.2022.09.015
      A 24-year-old woman presented with cough and dyspnea without obvious inducement over 10 days. Here body weight decreased by approximately 1 kg since the onset of the disease. The chest computed tomography revealed a large soft tissue density mass lesion located in the superior mediastinum with heterogeneous enhancement (Figure 1A-C) and sternal invasion (Figure 1D, arrow). Mild pericardial and pleural effusion with pericardial thickening was noted (Figure 1E-F, arrow). There was no evidence of synovial tissue involvement outside the thorax. CT-guided percutaneous biopsy revealed the mass as a spindle cell variant of adenocarcinoma. Immunohistochemistry of the biopsied sample showed cytokeratin 7 (CK7) (+), vimentin (Vim) (+) (Figure 2A-B), and epithelial membrane antigen (EMA) (+). A biphasic type of tumor consists of distinct epithelial and spindle cell components. Both epithelial and spindle cells are reactive to CK and EMA, whereas only the spindle cells are positive for Vim. Finally, a diagnosis of biphasic synovial sarcoma with a spindle cell component and an epithelial component of the mediastinum was confirmed.

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