CTICasesPrimary Mediastinal Synovial Sarcoma
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Imaging findings
Chest CT and MRI of a young patient demonstrate a large, heterogeneous, predominantly cystic mediastinal mass extending posterior to the aorta, around the pulmonary artery, and around the roof of the left atrium, accompanied by a pericardial effusion. MRI sequences reveal T1 and T2 hyperintensity with nodular internal enhancement and avid perfusion on subtraction sequences. Surgical resection confirmed a primary mediastinal synovial sarcoma invading the pericardium.
Key takeaways
Synovial sarcoma is an aggressive malignant mesenchymal tumor that typically arises near joints in the extremities but can rarely occur as a primary intrathoracic mass in the mediastinum, pleura, or lung parenchyma. On histopathology, these tumors are characterized by spindle cells and can be confirmed by identifying the characteristic chromosomal translocation t(X;18)(p11.2;q11.2).
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