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Ann Thorac Surg 2002;73:628-630
© 2002 The Society of Thoracic Surgeons

Case report

Mediastinal synovial sarcoma: report of two cases with molecular genetic analysis

Jacqueline K. Trupiano, MDa, Thomas W. Rice, MDb, Kevin Herzog, MDa, Frederic G. Barr, MDc, Janet Shipley, PhDd, Cyril Fisher, MDe, John R. Goldblum, MD*a

a Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
d Section of Molecular Carcinogenesis, Institute of Cancer Research, Haddow Laboratories, Belmont, Sutton, United Kingdom
e Histopathology Department, Royal Marsden Hospital, London, United Kingdom

Accepted for publication June 23, 2001.

* Address reprint requests to Dr Goldblum, Cleveland Clinic Foundation, 9500 Euclid Ave, L25, Cleveland, OH 44195, USA
e-mail: goldblj{at}ccf.org

Synovial sarcoma occurs predominantly in the paraarticular regions of the extremities. Synovial sarcoma of the mediastinum is an exceedingly rare neoplasm that has overlapping histologic and immunophenotypic features with other tumors in the differential diagnosis. We describe two cases. One is a 67-year-old patient who presented with chest pain and shortness of breath. Diagnostic imaging revealed a mediastinal mass extending over the cardiac apex. Histopathology, immunohistochemistry, and molecular genetic analysis confirmed the diagnosis of synovial sarcoma. The patient underwent surgical resection and postoperative radiation therapy. He is alive and well 18 months after diagnosis. This case illustrates the importance of proper procurement of frozen tissue for molecular genetic analysis for the identification of the t(X;18), characteristic of synovial sarcoma. Detection of this translocation is of paramount importance to confirm this diagnosis, particularly when this neoplasm arises in atypical locations outside the extremities.






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