Li Rui, Teng Xin, Han Wei-Hong, Li Yan, Liu Qing-Wei
Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China.
Department of Ultrasound, Qingdao Municipal Hospital, Shandong University, Qingdao 266000, Shandong Province, China.
World J Clin Cases. 2021 Mar 16;9(8):1893-1900. doi: 10.12998/wjcc.v9.i8.1893.
Synovial sarcoma (SS) accounting for 6%-10% of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs. Primary pulmonary SS (PPSS) is rare and has a poor prognosis. Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports. We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology, and shared valuable information on PPSS.
A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung. The results of a hemogram, erythrocyte sedimentation rate (ESR) and tumor markers were all within the normal range, tuberculin skin test (5 TU PPD) was negative (-). Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe. Thoracoscopic-assisted wedge resection of the right upper lobe of the lung, right upper lobe resection and lymph node dissection were performed. Nine months after surgery, ultrasound examination showed multiple metastases on the chest wall and kidney.
PPSS is a rare malignant lung tumor with strong invasiveness, early distant metastasis and poor prognosis. There are very few imaging reports. PPSS is often manifested as irregular tumor and calcification, and the metastases have extremely low echo on ultrasonography. Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement, manifested as "fast forward and fast regression".
滑膜肉瘤（SS）占原发性软组织恶性肿瘤的6%-10%，主要发生于四肢关节附近的深部软组织。原发性肺滑膜肉瘤（PPSS）罕见，预后较差。PPSS继发远处转移的病例很少见，且缺乏相应的影像学报道。我们总结了经手术及病理证实的多发转移PPSS的影像学表现，分享关于PPSS的有价值信息。
一名43岁女性患者右肺上叶有实性占位性病变。血常规、红细胞沉降率（ESR）及肿瘤标志物结果均在正常范围内，结核菌素皮肤试验（5 TU PPD）为阴性（-）。胸部计算机断层扫描检查显示右肺上叶后段有类似圆形的软组织密度影。行胸腔镜辅助下右肺上叶楔形切除术、右肺上叶切除术及淋巴结清扫术。术后9个月，超声检查显示胸壁和肾脏有多发转移灶。
PPSS是一种罕见的侵袭性强、早期远处转移且预后差的恶性肺肿瘤。影像学报道极少。PPSS常表现为不规则肿瘤及钙化，转移灶在超声检查时呈极低回声。超声造影显示肿瘤转移灶动脉期呈快速向心性高增强，表现为“快进快出”。
