Aggressive repeat surgery for a recurrent synovial sarcoma in the pleura.

Pleural synovial sarcomas are an extremely rare disease entity, and only 21 surgical cases, including this one, have been reported. We present a case of synovial sarcoma that underwent pneumonectomy for a recurrence of the disease. A 31-year-old female, who in June 2005 had undergone surgical resection of a monophasic synovial sarcoma in the left pleural cavity combined with the affected left diaphragm, was admitted to our hospital in January 2007 and underwent chemotherapy with ifosfamide, pirarubicin, and methotrexate for a recurrent synovial sarcoma in the left pleural cavity. The chest computed tomography revealed multiple tumors in the left pleura, and the tumors increased rapidly to occupy the left hemithorax. She began to complain of a severe dry cough. No other recurrent sites were found, and she underwent tumor resection combined with the entire left lung in March 2007. The tumor remained around the descending aorta. Pathological examination revealed dense proliferation of atypical spindle cells, the same findings as in the initial operation, and a diagnosis of synovial sarcoma was made. External radiation therapy up to 60 Gray was given to the tumor remaining around the descending aorta. She is now ambulatory without evidence of recurrent disease at 6 months after the second operation and 27 months after the initial surgery. Any aggressive repeat surgery as in the case here has not been previously reported. The present case suggests that aggressive tumor reduction followed by radiotherapy can achieve a good result for controlling local disease. Although optimal strategies for synovial sarcoma have yet to be established, aggressive repeat surgery could be considered in selected cases even when response to chemotherapy is insufficient and complete resection is difficult.