Feasibility and long-term outcomes of surgery for primary thoracic synovial sarcoma

Complex pediatric neoplasms: The role of congenital cardiothoracic surgery

Background

Surgery for pediatric solid neoplasms is often complicated by local tumor invasion. Cardiac surgeons can provide expertise in the chest and facilitate potentially aggressive management of tumors invading vasculature, pericardiac, or diaphragmatic spaces. Here we present 4 complex cases.

Methods

This descriptive retrospective chart review study included 4 surgical patients with locally invasive solid tumors.

Results

Case 1: 16 × 15.5 × 11 cm right chest synovial sarcoma in a male patient status post-neoadjuvant chemoradiation. Imaging revealed invasion of the right-sided subclavian vein, subclavian artery, phrenic nerve, and vagus nerve. The surgical approach via hemi-clamshell allowed for R0 resection. Case 2: Resection of a 17.6 × 10.5 × 8.1 cm sclerosing epithelioid fibrosarcoma originating from the vertebral body but causing aortic arch, right and left pulmonary artery, tracheal, and esophageal displacement. The surgeons preserved nearly all thoracic anatomy despite extensive periaortic and posterior mediastinal dissection. Case 3: Synchronous removal of a 11.5 × 9 × 5.5 cm pleuropulmonary blastoma at the time of tetralogy of Fallot repair. Case 4: Resection of a 12 × 0.5 × 0.3 cm nonviable Wilms tumor traversing from the right renal vein to the level of the Eustachian valve. All patients were extubated in the operating room and had an uneventful hospital course, with length of stay ranging from 5 to 10 days.

Conclusions

Pediatric patients may present with locally advanced heterogenous neoplasms. The added anatomic familiarity with the mediastinum, thoracic hilum, and great vessels in particular ensured safe resection in all cases. Thus, cardiothoracic surgery consultation is valuable when managing complex thoracic oncologic tumor resection.

Primary thoracic synovial sarcomas: clinical profile and treatment outcomes of a rare entity managed at a tertiary care centre

Introduction

Primary thoracic synovial sarcoma (PTSS) is a rare malignancy presenting with varying clinical manifestations. There is a paucity of data with few studies dedicated to this unique subset of neoplasms. We present our findings from one of the largest real-world studies among patients with PTSS.

Methods

This is a single-centre, real-world study in patients with PTSS included between 2017 and 2023. Survival estimates were obtained by the Kaplan-Meier method and Cox regression analysis.

Results

24 patients with a median age of 34.5 years (range 16-54) presented with chest pain (n = 11, 45.8%) and dyspnea (n = 10, 41.6%). Predominant primary sites of disease were the lung (n = 12, 50%) and mediastinum (n = 6, 25%). The stage at presentation was unresectable locally advanced (n = 10, 41.6%), localised (n = 8, 33.3%) and metastatic (n = 6, 25%) with pulmonary metastases (n = 10, 62.5%) and pleural effusion (n = 4, 25%). 16 (66.6%) patients underwent surgical resection including 7 (43.8%) who received neoadjuvant chemotherapy (NACT). NACT was given in ten patients producing stable disease in 5 (50%) and partial response in 3 (30%) patients, respectively, with surgery performed in 7 (70%). 11 (62.5%) operated patients had a microscopically complete resection and 10 (41.6%) received postoperative radiotherapy. Anthracyclines were given in 23 (95.8%) patients in the first line, while pazopanib was the most common therapy in the second and third lines, respectively. At a median follow-up of 32 months (range 16.7-47.2), the median overall survival (OS) was 41 months (95% CI: 23.7-58.2) and 8 months (95% CI: 1-25.6) overall and in metastatic disease, respectively. Presentation with metastases (p = 0.01) and treatment with surgical resection (p = 0.005) were significantly associated with OS on univariate analysis.

Interpretation

The locally advanced nature of the disease at presentation signifies the need for early diagnosis and technically superior definitive therapies. The survival outcomes for metastatic disease remain poor and the need for novel therapies for advanced disease remains unmet so far.

Clinical trial registration

Not applicable.

Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma

BACKGROUND

Pleural neoplasms are rare and can be subdivided into pleural metastasis and primary pleural neoplasms. Non-mesothelioma primary pleural neoplasms are a diverse group of extremely rare pathologies.

CASE PRESENTATION

In this case series, we describe the presentation and management of two rare primary pleural neoplasms. A first case describes a primary pleural yolk sac tumor treated with neoadjuvant chemotherapy, extended pleurectomy decortication, and hyperthermic intrathoracic chemotherapy. In a second case we describe the management of a primary pleural synovial sarcoma by neoadjuvant chemotherapy and extrapleural pneumonectomy. A complete resection was obtained in both cases and the post-operative course was uncomplicated. No signs of tumor recurrence were noted during follow-up in the first patient. In the second patient a local recurrence was diagnosed 6 months after surgery.

CONCLUSION

Neo-adjuvant chemotherapy followed by extensive thoracic surgery, including hyperthermic intrathoracic chemotherapy, is a feasible treatment strategy for non-mesothelioma primary pleural neoplasms, but careful follow-up is required.