A case of pulmonary metastasis from synovial sarcoma with invasion of the main pulmonary artery

Abstract

The patient was a 33-year-old woman who had undergone extensive resection for synovial sarcoma in the left thigh. Three years after the surgery, CT revealed two metastatic tumors in the right lower lobe of the lung (S⁶, S⁷). She received right middle and lower lobectomies because the tumor in S⁶ had invaded the intermediate pulmonary artery. Eight years after the pulmonary resection, CT revealed a pulmonary nodule shadow, indicating invasion of the right main pulmonary artery. We diagnosed this abnormal shadow as recurrent synovial sarcoma. Consequently, we adopted an intrapericardial approach via a median sternotomy, and could easily cut off the right main pulmonary artery and pulmonary vein in the pericardium. We followed the procedure to separate adhesive parts from the lung, but massive bleeding was caused by collateral blood flow from the chest wall. We added trans-sternal thoracotomy and then we performed completion pneumonectomy. When the lung adheres firmly and adhesiotomy may cause massive bleeding, we recommend cutting off the pulmonary vein after adhesiotomy, even if we can easily cut off the pulmonary artery and vein in the pericardium.