Aggressive pulmonary metastasectomies for synovial sarcoma

Radiofrequency thermal ablation of primary pleural synovial sarcoma

Percutaneous radiofrequency (RF) thermal ablation has received attention as an effective minimally invasive approach for the treatment of a variety of neoplasms. However, the therapeutic efficacy of RF thermal ablation on primary pleural synovial sarcoma has not yet been reported. A 76-year-old man with a primary pleural synovial sarcoma who was medically inoperable received RF thermal ablation to achieve local control. Therefore, an RF electrode was inserted into the lesion and connected to an RF generator. In this report, a case of successful treatment of a primary pleural synovial sarcoma using RF ablation without complication is presented.

[Primary pulmonary synovial sarcoma: a report and diagnosis of 2 cases]

Synovial sarcoma is an extremely rare primary pulmonary tumor whose description is based on a limited number of cases. We report two cases diagnosed by thoracotomy. One patient was initially treated surgically, and a later recurrence was controlled by combined chemotherapy and a second operation after three years of monitoring. In the second case, surgery was imperative to treat massive hemoptysis and was followed by combined chemotherapy after diagnosis of lesions consistent with extrapulmonary metastasis.

[Surgical resection of recurrent pulmonary metastases]

The lung is a common site of metastasis. Resectability seems to be the only prognostic factor acknowledged in the literature. Other variables, such as time until tumoral reproduction, duration of the disease-free period, number of metastases and ganglia involvement are not grounds for ruling out surgery. Between February 1996 and January 1998 we operated on 45 patients with pulmonary metastasis, 16 of whom underwent surgery for the same reason more than once. The total number of chest operations in the study group was 42. Retrospectively, we studied all patients undergoing chest surgery more than once, with histologically confirmed resection of pulmonary metastases. One hundred twenty-five metastases (7.8 metastases/patient) were resected. We recorded 3 cases of persistent air leaks that stopped after aspiration through chest tubes was continued. No postoperative (1 to 30 days) mortality was observed. Repetition of pulmonary metastasis should not by itself be considered a reason for ruling out surgery.