WCLC 2025 - Posters & ePosters-EP.14.24 Report of Four Cases of Primary Pulmonary Sarcoma Experienced at Our Hospital

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This report presents four cases of primary pulmonary sarcoma treated over 26 years at a single hospital, highlighting the rarity and diagnostic challenges of this malignancy, which accounts for roughly 0.5% of primary lung tumors. Sarcomas are aggressive mesenchymal tumors with poor prognosis and limited response to chemotherapy or radiation.<br /><br />Case 1 involved a 29-year-old non-smoking female presenting with left chest pain and bloody sputum. Initial imaging showed a tumor with low FDG-PET uptake that shrank and cavitated after antibiotic treatment, delaying suspicion for malignancy. After about 2.5 years, the tumor regrew with pleural effusion and hemorrhage, leading to emergency thoracoscopic left lower lobectomy. Pathology identified synovial sarcoma characterized by spindle-shaped atypical cells and positive SS18 fusion gene detection. <br /><br />Case 2 was a 65-year-old male smoker with cough who underwent left pneumonectomy with pulmonary artery reconstruction for intimal sarcoma but died from tumor embolism the next day. <br /><br />Cases 3 and 4 involved male smokers presenting with bloody sputum who underwent curative surgery (left upper lobectomy and right lower partial resection) for synovial sarcoma and liposarcoma, respectively. Both patients showed no recurrence for over 7-10 years postoperatively.<br /><br />The analysis emphasizes the diagnostic difficulty due to transient tumor shrinkage and low FDG-PET uptake possibly caused by hematoma absorption or infection treatment, underscoring the need for vigilant follow-up. Synovial sarcoma typically affects younger adults and FDG-PET uptake varies widely; higher uptake correlates with worse outcomes. Complete surgical resection remains crucial for long-term survival.<br /><br />In conclusion, primary pulmonary sarcoma, though extremely rare and often overlooked in differential diagnosis, requires early detection and consideration to improve prognosis. Surgical management is the mainstay due to poor chemo/radiotherapy response. Careful follow-up is essential even if initial imaging suggests benign changes.

Asset Subtitle

Yoshiyuki Mishina

Meta Tag

Speaker Yoshiyuki Mishina

Topic Mesothelioma, Thymoma, and Other Thoracic Tumors

Keywords

primary pulmonary sarcoma

synovial sarcoma

liposarcoma

FDG-PET uptake

thoracoscopic lobectomy

pulmonary artery reconstruction

tumor embolism

mesenchymal tumors

surgical resection

diagnostic challenges