Pleuropulmonary synovial sarcoma (PPSS) is an extreme- ly rare primary malignancy of the lung. We present a case of a middle-aged female with PPSS that was initially dis- covered as an incidental indeterminate nodule on chest radiograph. Following evaluation with computed tomog- raphy (CT), the patient went on to positron-emission tomography (PET)/CT for work-up of the solitary pulmo- nary nodule, which demonstrated mild FDG-avidity and no other evidence of FDG-avid disease. The patient then underwent thoracotomy and right upper lobectomy for definitive treatment. Only after evaluation of the gross pathology, histology, immunohistochemistry and cytoge- netics was the diagnosis of synovial sarcoma made. Im- portantly, the preceding PET/CT, in addition to physical exam of the upper and lower extremities, helped exclude the more common extra-thoracic soft-tissue variety of synovial sarcoma, which frequently metastasizes to lung, carrying a worse prognosis. Discussion of synovial sarcoma and PPSS follows.
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