Observation
We report the case of a 61-year-old patient, smoking 40 pack-year with a history of ischemic heart disease and hypertension. The patient consulted for a persistent right chest pain evolving for 3 months with low abundance hemoptysis in a context of weight loss of 3-4 kg for 2 months, asthenia and anorexia. A series of explorations eliminated a cardiac origin of the thoracic pain. Chest X- ray revealed a lung mass measuring about 10 cm [Figure 1]. Chest CT confirmed the presence of a large heterogeneous mass in the right upper lobar, massively necrotic, adhering to the trachea, laminating the superior vena cava and pushing the esophagus to the left, measuring 14 cm long [Figure 2] without notable mediastinal, hilar, or axillary adenopathy, or adjacent bone involvement. A CT-guided lung biopsy concluded that the pulmonary synovialosarcoma was largely necrotic. In view of this histological type, a meticulous clinical examination did not find a primary tumour, particularly
in the soft tissues and in the periarticular area, so the primary pulmonary origin was retained. The remote extension assessment was negative. This case was discussed at a multidisciplinary concertation meeting and the resectability of the tumour was rejected in view of the locoregional extension and mediastinal invasion. The patient was referred to the oncology department for radiochemotherapy.