SHM Converge Scientific Abstract ePoster Gallery-A Case of Synovial Sarcoma Manifesting as Pseudo-Subclavian Steal Syndrome

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This case describes a rare pulmonary synovial sarcoma presenting with neurologic symptoms caused by tumor-related vascular effects rather than direct brain disease. Synovial sarcomas are aggressive, often hypervascular tumors that usually arise near joints but can, uncommonly, originate in the lung.<br /><br />A 37-year-old man with type 2 diabetes presented with bifrontal and retro-orbital headache, left facial and upper-extremity numbness, generalized weakness, and dysarthria. He had a similar episode a week earlier that lasted 12 hours and was associated with syncope. Over the prior month, he also reported unintentional weight loss, shortness of breath, lower-extremity numbness, and subjective fevers. He had no tobacco or illicit drug use. Laboratory studies were normal. CT of the head showed no hemorrhage, ischemia, or structural lesion.<br /><br />CT of the chest revealed a well-circumscribed, highly vascular soft tissue mass in the left mid-thorax abutting the mediastinum, with pulmonary arterial branches and bronchi coursing through it. Biopsy showed a high-grade spindle cell neoplasm infiltrating lung tissue, and immunostaining confirmed monophasic synovial sarcoma.<br /><br />The patient’s neurologic symptoms were explained by cerebral hypoperfusion from compression of the left ventricle and pseudo-subclavian steal physiology caused by the tumor’s abnormal blood flow and vascular shunting. This led to vertebrobasilar insufficiency, which can cause headache, fatigue, syncope, dysarthria, gait instability, and unilateral numbness.<br /><br />He was discharged and later underwent surgical resection.<br /><br />Key teaching points: pulmonary synovial sarcomas can be markedly hypervascular, displace native vessels, and produce symptoms of hypoperfusion. Prompt recognition of this unusual presentation can expedite diagnosis and treatment.

Asset Subtitle

Alexa M. Giammarino

Meta Tag

Author List Alexa M. Giammarino, Bryant Faria

Category Clinical Vignettes

Concept Synovial Sarcoma

Concept Hypervascularity

Concept Pseudo-Subclavian Steal Syndrome

Concept Vertebrobasilar Hypoperfusion

Concept High-Grade Spindle Cell Neoplasm

Distinguished Non-Finalist

Presenter Organization Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health

Presenting Author Alexa M. Giammarino

Track Adult

Keywords

pulmonary synovial sarcoma

hypervascular thoracic mass

vertebrobasilar insufficiency

cerebral hypoperfusion

pseudo-subclavian steal

dysarthria

syncope

spindle cell neoplasm

mediastinal mass

lung tumor

Synovial Sarcoma

Hypervascularity

Pseudo-Subclavian Steal Syndrome

Vertebrobasilar Hypoperfusion

High-Grade Spindle Cell Neoplasm