Jedlicka V, Dolezel J, Vlcek P, Pestál A, Veselý K, Bednarík O, Capov I
I. Chirurgická klinika FN u sv. Anny a LF MU v Brne, Brno.
Rozhl Chir. 2007 Feb;86(2):85-8.
Synovial sarcoma is the rare indication for the pulmonary metastasectomy due to its aggressive biologic behavior and early dissemination. The radical surgical approach in therapy of the multiple pulmonary metastases could improve quality of life and median survival in carefully selected patients.
From the group of 7 patients with the lung metastases of the synovial sarcoma operated in our department during the last 5 years we are presenting the case of the 39 years old man with the previous history of the surgical removal of the synovial sarcoma near the cubital fossa one year before. Considering the lungs as the only organ involved, bilateral complete metastasectomy through muscle sparing vertical thoracotomies was done. There were 12 metastases from all lung lobes with the exception of the right middle lobe. Analysis of the pathologist showed biphasic metastatic synovial sarcoma with the high mitotic activity. The 6 cycles of the MAID regime succeeded.
Median survival of the whole group is 25 months, there are 3 patients alive. In the above mentioned patient 1 year after the metastasectomy PET-CT showed focus of the 4th left rib suspected to be malignant. Wide resection of the rib was done, but no malignancy was disclosed, there were only reparative changes. The patient has been tolerated the oncological treatment very well and 45 months after the lung metastasectomy there are no sings of a malignant disease.
Lung metastasectomy of the multiple lung metastases of the synovial sarcoma is of value despite of uncertain long-term prognosis. It is recommended to consider the metastasectomy even in low differentiated tumors. The prerequisite for the effective treatment is a complete resection.
滑膜肉瘤因其侵袭性生物学行为和早期转移，是肺转移瘤切除术的罕见适应证。对于精心挑选的患者，采用根治性手术方法治疗多发性肺转移瘤可改善生活质量和中位生存期。
在过去5年中，我们科室为7例滑膜肉瘤肺转移患者进行了手术，现介绍其中1例39岁男性患者的病例。该患者1年前曾接受过肘窝附近滑膜肉瘤的手术切除。鉴于肺部是唯一受累器官，通过保留肌肉的垂直开胸术进行了双侧完整的转移瘤切除术。除右中叶外，所有肺叶均有12个转移瘤。病理学家分析显示为双相转移性滑膜肉瘤，有高有丝分裂活性。MAID方案的6个周期治疗成功。
全组患者的中位生存期为25个月，有3例患者存活。在上述患者中，转移瘤切除术后1年，PET-CT显示左第4肋骨有疑似恶性的病灶。对该肋骨进行了广泛切除，但未发现恶性肿瘤，仅有修复性改变。该患者对肿瘤治疗耐受性良好，肺转移瘤切除术后45个月未出现恶性疾病迹象。
尽管滑膜肉瘤多发性肺转移瘤的长期预后不确定，但肺转移瘤切除术仍有价值。即使是低分化肿瘤，也建议考虑进行转移瘤切除术。有效治疗的前提是完整切除。
