Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Medicine (Baltimore). 2023 Dec 22;102(51):e36620. doi: 10.1097/MD.0000000000036620.
Primary pulmonary synovial sarcoma is a rare malignant pulmonary tumor accompanied by calcifications in approximately 15% of cases. These calcifications usually have a fine, stippled appearance; coarse shapes have seldom been reported. Moreover, the presence of coarse calcifications often suggests benign tumors, which vastly differ in treatment. We present a rare case of primary pulmonary sarcoma with coarse intratumoral calcifications, the diagnosis of which was delayed because of its radiologic appearance.
A computed tomography (CT) scan of a 69-year-old man with right upper quadrant (RUQ) pain revealed an incidental mass at the base of the right lower lobe, the margin of which was not well described with respect to the liver, and intratumoral coarse calcification was noted. Initially, the lesion was believed to be hepatic, and magnetic resonance imaging (MRI) was performed. Based on its imaging features, the mass was thought to be a pulmonary lesion, and a preliminary diagnosis of a benign lesion, such as a hamartoma or granuloma, was made. Four months after the initial CT scan, the patient's RUQ pain had aggravated; however, no change in the mass was observed on follow-up CT.
The final diagnosis was primary pulmonary sarcoma, proven by surgical biopsy.
Wedge resection of the right lower lobe was performed, and the patient received adjuvant chemotherapy.
The patient's RUQ pain improved, and no recurrence or metastasis has been reported to date.
This case describes a rare presentation of a primary pulmonary synovial sarcoma with coarse intratumoral calcifications and the MRI features of the lesion. Intratumoral coarse calcifications often suggest benign lesions, such as hamartomas or post-inflammatory granulomas; however, as malignant lesions cannot be completely excluded, other radiologic and clinical features should be considered carefully. Focal areas of enhancement and eccentric calcification distribution might suggest malignant lesions such as primary pulmonary synovial sarcoma. Furthermore, despite not being used routinely, MRI scans might be helpful because advanced MRI techniques, such as diffusion-weighted imaging, can help distinguish malignant lesions from benign lesions. If the clinical course of a patient suggests malignancy, a more aggressive biopsy strategy should be considered.
原发性肺滑膜肉瘤是一种罕见的肺部恶性肿瘤，约 15%的病例伴有钙化。这些钙化通常呈细点状；粗形状则很少报道。此外，粗钙化的存在常提示良性肿瘤，两者的治疗方法有很大的不同。我们报告了一例罕见的原发性肺肉瘤伴粗肿瘤内钙化，由于其影像学表现，诊断被延误。
一名 69 岁男性因右上腹（RUQ）疼痛进行计算机断层扫描（CT）检查，发现右下叶基底有一偶然发现的肿块，其与肝脏的边界描述不明确，且肿瘤内有粗钙化。最初，病变被认为是肝脏病变，进行了磁共振成像（MRI）检查。根据其影像学特征，该肿块被认为是肺部病变，初步诊断为良性病变，如错构瘤或肉芽肿。在初次 CT 扫描后 4 个月，患者的 RUQ 疼痛加重；然而，在后续 CT 检查中未见肿块变化。
通过手术活检证实为原发性肺肉瘤。
行右下叶楔形切除术，患者接受辅助化疗。
患者的 RUQ 疼痛改善，至今未报告复发或转移。
本病例描述了一例罕见的原发性肺滑膜肉瘤伴粗肿瘤内钙化和病变的 MRI 特征。肿瘤内粗钙化通常提示良性病变，如错构瘤或炎症后肉芽肿；然而，由于不能完全排除恶性病变，应仔细考虑其他影像学和临床特征。局灶性增强和偏心性钙化分布可能提示恶性病变，如原发性肺滑膜肉瘤。此外，尽管未常规使用，MRI 扫描可能会有所帮助，因为高级 MRI 技术，如弥散加权成像，可以帮助区分恶性和良性病变。如果患者的临床过程提示恶性肿瘤，应考虑更具侵袭性的活检策略。
