Sebanayagam Vinoja, Alkassis Samer, Alshare Bayan, Thati Neelima
Hematology and Oncology, Wayne State University School of Medicine, Detroit, USA.
Internal Medicine, Wayne State University School of Medicine, Detroit, USA.
Cureus. 2020 Oct 14;12(10):e10945. doi: 10.7759/cureus.10945.
Synovial sarcomas are rare malignant tumors that originate from primitive pluripotent mesenchymal stem cells that look similar to the developing synovium, but are histologically unrelated to it. Sarcomas commonly metastasize to the lungs and surrounding pleura, with a documented incidence as high as 85% for pleural-based metastases. The incidence of spontaneous pneumothorax in patients with sarcomas is only 1.9%, with synovial sarcoma being the third most common type of sarcoma associated with pneumothorax. While surgical resection is usually the treatment for localized primary synovial cell sarcoma, metastatic disease requires systemic therapy, mainly chemotherapy. Failure of chemotherapy calls for the use of targeted therapeutic agents such as pazopanib. Pazopanib has been linked to the incidence of spontaneous pneumothorax in previous case studies. However, primary research fails to establish a statistically significant causal association. Research shows that pneumothorax can result from lung metastases independent of therapeutic side effects. We report a case of synovial sarcoma of trapezius origin with secondary lung metastases, and development of pneumothorax after pazopanib treatment. We discuss the incidence of pneumothorax as a medication side effect versus independent effect of natural disease progression, and how this plays role in deciding when to continue using a medication in the face of complications.
滑膜肉瘤是一种罕见的恶性肿瘤，起源于原始多能间充质干细胞，这些干细胞看起来与发育中的滑膜相似，但在组织学上与其无关。肉瘤通常会转移至肺部及周围胸膜，据记载，胸膜转移的发生率高达85%。肉瘤患者发生自发性气胸的发生率仅为1.9%，滑膜肉瘤是与气胸相关的第三常见肉瘤类型。虽然手术切除通常是局限性原发性滑膜细胞肉瘤的治疗方法，但转移性疾病需要全身治疗，主要是化疗。化疗失败需要使用靶向治疗药物，如帕唑帕尼。在先前的病例研究中，帕唑帕尼与自发性气胸的发生率有关。然而，初步研究未能建立具有统计学意义的因果关系。研究表明，气胸可能由肺转移引起，与治疗副作用无关。我们报告一例起源于斜方肌的滑膜肉瘤伴继发性肺转移，并在帕唑帕尼治疗后发生气胸的病例。我们讨论了气胸作为药物副作用与自然疾病进展的独立作用的发生率，以及这在面对并发症时决定何时继续使用药物中所起的作用。
