2026年 · 第106卷第02期

The patient, a 73-year-old male, was admitted to the Department of Thoracic Oncology of Qingdao Municipal Hospital on April 30, 2023 due to "chest pain for 1 month". Admission specialist physical examination left lower lung breathing sound was weakened, both lungs did not hear rales. Negative nucleic acid test for common respiratory pathogens; Lung cancer-related tumor markers: carcinoembryonic antigen (CEA) was 23.52 μ g/L, neuron-specific enolase (NSE) was 23.64 μ g/L, soluble cytokeratin 19 fragment (CYFRA21-1) was 4.62 μ g/L, and squamous cell carcinoma antigen was 1.8 μ g/L. On May 2, 2023, the enhanced CT of the chest showed a massive soft tissue density shadow in the subpleural area of the left lung, with a larger cross section of about 64 mm ×80 mm. After the enhanced scan, it showed uneven enhancement (Figures A and B), and there was no adhesion between the lower edge of the tumor and the chest wall and parietal pleura (Figure C). Four days after admission, CT-guided puncture biopsy was performed to confirm the diagnosis. The pathological results showed that the tumor cells were oval and fusiform, diffusely distributed, and the mitotic images were more common (Figure D, hematoxylin-eosin staining ×100). Immunohistochemical results showed CK (-), Vimentin (+), TTF-1 (-), WT-1 (-), CD34 (-), S100 (-), CD99 (+), BCL2 (weakly positive), EMA (-). The final diagnosis was primary pulmonary synovial sarcoma (PPSS). The patient refused surgery and chemoradiotherapy, oral anlotinib and symptomatic supportive treatment. In December 2023, the patient died of respiratory failure in the end stage of the tumor. PPSS is a rare malignant tumor originating from the internal mesenchymal tissue of the lung, which often appears clinically with chest pain, cough, dyspnea and other symptoms. Chest CT usually shows a large soft tissue mass in the lungs or under the pleura, with significantly uneven enhancement on enhancement scans. The diagnosis of this disease mainly depends on pathology, which is characterized by tumor cells in spindle or epithelial arrangement, and immunohistochemistry shows positive antibodies such as Vimentin and CD99. PPSS are highly aggressive, and early diagnosis and treatment are the key to improve prognosis.