[Multiple lung metastasectomy for the poor differentiated metastatic synovial sarcoma].

Objectives: Synovial sarcoma is the rare indication for the pulmonary metastasectomy due to its aggressive biologic behavior and early dissemination. The radical surgical approach in therapy of the multiple pulmonary metastases could improve quality of life and median survival in carefully selected patients.

Methods: From the group of 7 patients with the lung metastases of the synovial sarcoma operated in our department during the last 5 years we are presenting the case of the 39 years old man with the previous history of the surgical removal of the synovial sarcoma near the cubital fossa one year before. Considering the lungs as the only organ involved, bilateral complete metastasectomy through muscle sparing vertical thoracotomies was done. There were 12 metastases from all lung lobes with the exception of the right middle lobe. Analysis of the pathologist showed biphasic metastatic synovial sarcoma with the high mitotic activity. The 6 cycles of the MAID regime succeeded.

Results: Median survival of the whole group is 25 months, there are 3 patients alive. In the above mentioned patient 1 year after the metastasectomy PET-CT showed focus of the 4th left rib suspected to be malignant. Wide resection of the rib was done, but no malignancy was disclosed, there were only reparative changes. The patient has been tolerated the oncological treatment very well and 45 months after the lung metastasectomy there are no sings of a malignant disease.

Conclusion: Lung metastasectomy of the multiple lung metastases of the synovial sarcoma is of value despite of uncertain long-term prognosis. It is recommended to consider the metastasectomy even in low differentiated tumors. The prerequisite for the effective treatment is a complete resection.