Neşe DURSUNOĞLU, Serkan DEĞİRMENCİOĞLU, Arzu YAREN, Nagehan ÇOLAKOĞLU, Esma ÖZTÜRK, Pınar TUNÇ, Göksel KITER

An old woman with weight loss and chest pain

Pulmoner sarkomlar, tüm primer akciğer sarkomalarının sadece %0.1-0.5’ini oluşturur. Bu tümörler akciğer parankimi, bronş ağacı veya pulmoner arterlerden köken alabilir. Ayırıcı tanıda en önemli nokta metastatik sinovyal sarkom ile ayırıcı tanısını yapmaktır. Yetmiş altı yaşında kadın hasta, son bir aydır süregiden ateş, öksürük, balgam, kilo kaybı ve sol yan ağrısı ile başvurdu. Toraks tomografisinde genişlemiş mediastinal lenf nodları ve sol plevral efüzyon saptandı. Torasentezinde hemorajik görünümlü, lenfosit hakimiyetli eksüda karakterinde sıvı saptandı ve kapalı plevra biyopsisi kronik inflamasyon gösterdi. Lokal anestezi ile yapılan sol torakoskopisinde sol akciğerde total kollaps ve viseral plevrada çok sayıda nodüller görüldü ve bu nodüllerden çok sayıda biyopsiler alındı. Patolojik tanısı “sinovyal sarkom” olarak kondu. İskelet single foton emisyon tomografisinde başka bir lezyon saptanmadı ve hasta primer plöropulmoner sinovyal sarkom olarak kabul edilerek kemoterapisi planlandı. Sonuç olarak, primer plöropulmoner sinovyal sarkom akciğer ve plevranın nadir rastlanan ancak prognozu kötü olan bir neoplazisidir.

Göğüs ağrısı ve kilo kaybı ile başvuran yaşlı kadın hasta

Pulmonary sarcomas constitute only 0.1-0.5% of all primary lung malignancies. These tumors may derive from the lung parenchyma, bronchial tree or pulmonary arteries. The most important entity in the differential diagnosis is metastatic synovial sarcoma. A 76-years-old woman was admitted for investigation of a fever, productive cough, dyspnea, weight loss and left-sided chest pain which had been present for one month. A chest computerised tomography showed enlarged mediastinal lymph nodes were observed, as well as a left-sided pleural effusion. Thoracentesis revealed hemorrhagic pleural effusion which was exudate and lymphocyte predominant, closed pleural biopsy showed chronic inflammation. Left sided thoracoscopy was performed under local anesthesia, total collapse of left lung and multiple pleural nodules were observed on the visceral pleura multiple biopsies were obtained from those nodules. Pathologic examinations revealed “synovial sarcoma”. As skeleton single photon emission tomography was unremarkable, primary pleuropulmonary synovial sarcoma was decided as diagnosis and chemotheraphy was planned for the patient. Primary pleuropulmonary synovial sarcoma is a rare neoplasm of lung and pleura but it is rare entity.

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