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      An unusual endobronchial lesion: expanding the differential diagnosis

      case-report

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          Abstract

          Synovial sarcoma is a rare tumour, accounting for approximately 2.5–10% of all soft tissue sarcomas. In the thorax, it most often presents as a large, homogenous mass and, most commonly, is the result of extrathoracic tumour metastasis. Here, we report a case of a 73‐year‐old male who presented to the hospital after a motor vehicle collision. Chest computed tomography demonstrated a 2.0 × 2.4 cm left lower lobe pulmonary nodule with endobronchial extension and a 2.5 × 2.1 cm right‐sided kidney mass. He was eventually diagnosed with monophasic synovial sarcoma. To date, only seven other cases of primary pulmonary synovial sarcoma with endobronchial extension have been reported. A review of the cases and literature is discussed.

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          Most cited references15

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          Synovial sarcoma: defining features and diagnostic evolution.

          Synovial sarcoma (SS) is a malignant mesenchymal neoplasm with variable epithelial differentiation, with a propensity to occur in young adults and which can arise at almost any site. It is generally viewed and treated as a high-grade sarcoma. As one of the first sarcomas to be defined by the presence of a specific chromosomal translocation leading to the production of the SS18-SSX fusion oncogene, it is perhaps the archetypal "translocation-associated sarcoma," and its translocation remains unique to this tumor type. Synovial sarcoma has a variety of morphologic patterns, but its chief forms are the classic biphasic pattern, of glandular or solid epithelial structures with monomorphic spindle cells and the monophasic pattern, of fascicles of spindle cells with only immunohistochemical or ultrastructural evidence of epithelial differentiation. However, there is significant morphologic heterogeneity and overlap with a variety of other neoplasms, which can cause diagnostic challenge, particularly as the immunoprofile is varied, SS18-SSX is not detected in 100% of SSs, and they may occur at unusual sites. Correct diagnosis is clinically important, due to the relative chemosensitivity of SS in relation to other sarcomas, for prognostication and because of the potential for treatment with specific targeted therapies in the near future. We review SS, with emphasis on the diagnostic spectrum, recent immunohistochemical and genetic findings, and the differential diagnosis.
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            Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis

            BACKGROUND: Invasive procedures such as bronchoscopic biopsy, bronchial washing, and bronchial brushing are widely used in diagnosis of lung cancers. The mean diagnostic rate with bronchoscopic forceps biopsy is 74% in central tumors. This study was designed to evaluate the efficacy of cryobiopsies in histopathological diagnosis. METHODS: Forty-one patients who had interventional bronchoscopy were included in this study. Three forceps biopsies and one cryobiopsy with cryorecanalization probe were obtained from each subject. Biopsies interpretations were done by one expert pathologist. RESULTS: Hemorrhage was the only complication in both procedures. There was no significant difference between these two procedures in the incidence of hemorrhage (P > 0.05). Mean diameters of samples taken with forceps biopsy and cryoprobe biopsy were 0.2 and 0.8 cm, respectively (P < 0.001). Thirty-two patients (78%) were diagnosed with forceps biopsies, and 38 patients (92.7%) were diagnosed with cryoprobe biopsies (P = 0.031). CONCLUSIONS: We concluded that cryoprobe biopsies were more successful than forceps biopsies in diagnosis. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy.
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              Tracheobronchial tumors.

              Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.
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                Author and article information

                Contributors
                raleonard@hsc.wvu.edu
                Journal
                Respirol Case Rep
                Respirol Case Rep
                10.1002/(ISSN)2051-3380
                RCR2
                Respirology Case Reports
                John Wiley & Sons, Ltd (Chichester, UK )
                2051-3380
                19 April 2019
                July 2019
                : 7
                : 5 ( doiID: 10.1002/rcr2.v7.5 )
                : e0429
                Affiliations
                [ 1 ] Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine West Virginia University Morgantown West Virginia USA
                [ 2 ] Department of Pathology West Virginia University Morgantown West Virginia USA
                Author notes
                [*] [* ] Correspondence

                Rachel Leonard, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA. E‐mail: raleonard@ 123456hsc.wvu.edu

                Author information
                https://orcid.org/0000-0003-3521-5311
                Article
                RCR2429
                10.1002/rcr2.429
                6474780
                31019717
                603d83b5-8640-4d30-9614-50b83ceafb10
                © 2019 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 January 2019
                : 11 March 2019
                : 01 April 2019
                Page count
                Figures: 3, Tables: 1, Pages: 5, Words: 2431
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                rcr2429
                July 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:19.04.2019

                endobronchial lesion,lung,synovial sarcoma
                endobronchial lesion, lung, synovial sarcoma

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