Sarcomatous lesions of Mediastinum - An unchartered territory: A tale of two case reports

Abstract

Various primary and metastatic malignant lesions can occur in the mediastinumandmay cause diagnostic dilemmas in achieving definitive diagnosis. Synovial sarcoma is a malignant neoplasm predominantly affecting soft tissues of the extremities of adolescents and young adults. Its occurrence as a primary neoplasm in mediastinum is rare. Ewing's sarcomas are also rare high grade malignant neoplasms that predominantly affect children and young adults and involve the major long bones, pelvis, and ribs. Primary mediastinal Ewing's sarcoma is extremely rare. We, hereby, presenttwo unusual casesof sarcoma in mediastinum. First case was a 62 year old male patient presented withchest pain and cough. Microscopic examinations of the resected mediastinal tumor showed areas of epithelial differentiation with well-formed glandular spaces intimately admixed with monotonous population of plump spindle-shaped cells confirming the diagnosis of synovial sarcoma. Another case of 23 years old male patient presented with chest pain and cough. Microscopic examinations of the mediastinal mass revealed presence of a tumor tissue composed of sheets and nests of small round cells with hyperchromatic nuclei and scanty cytoplasm. Histopathological diagnosis of Ewings sarcoma was made. In conclusion, it can be said that mediastinum could be rarest of the rare locations for primary sarcomas our search for literature also revealed very few cases across the globe which imparts further credence to the true rarity of the neoplasm. Early management by the oncologist may be hindered further owing to diverse differential diagnosis unless surgical pathologists undertake a cautious pragmatic approach.