Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma

Our plain-English summary of Extensive surgical resections for rare pleural neoplasms: a single-center experience with a yolk sac tumor and synovial sarcoma, by T. Vandaele, J. Van Slambrouck, P. Schöffski, et al (World Journal of Surgical Oncology, 2024).

The study

• Authors: T. Vandaele, J. Van Slambrouck, P. Schöffski, H. Dumez, B. Weynand, R. Sciot, A. Barbarossa, A.L. Provoost, K. Van de Voorde, Y. Debaveye, S. Bouneb, P. Nafteux, L.J. Ceulemans
• Journal: World Journal of Surgical Oncology
• Published: 2024;22(1):96
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural neoplasms are rare and can be subdivided into pleural metastasis and primary pleural neoplasms. Non-mesothelioma primary pleural neoplasms are a diverse group of extremely rare pathologies.

Case Presentation: In this case series, we describe the presentation and management of two rare primary pleural neoplasms. A first case describes a primary pleural yolk sac tumor treated with neoadjuvant chemotherapy, extended pleurectomy decortication, and hyperthermic intrathoracic chemotherapy. In a second case we describe the management of a primary pleural synovial sarcoma by neoadjuvant chemotherapy and extrapleural pneumonectomy. A complete resection was obtained in both cases and the post-operative course was uncomplicated. No signs of tumor recurrence were noted during follow-up in the first patient. In the second patient a local recurrence was diagnosed 6 months after surgery.

Conclusion: Neo-adjuvant chemotherapy followed by extensive thoracic surgery, including hyperthermic intrathoracic chemotherapy, is a feasible treatment strategy for non-mesothelioma primary pleural neoplasms, but careful follow-up is required.

© 2024. The Author(s).

In plain English

This case series from University Hospitals Leuven, Belgium, described two patients with rare cancers that started in the pleura (the lining around the lungs) and were not mesothelioma. The article does not mention asbestos. A 37-year-old woman had a pleural yolk sac tumor. She received chemotherapy, then surgery that removed the pleura, the left diaphragm and part of the heart lining, followed by heated chemotherapy (oxaliplatin) washed through the chest. The tumor was completely removed, though tissue showed very little response to chemotherapy. She left hospital on day 26 after surgery, and a later scan showed no sign of the tumor returning. A 26-year-old man had a pleural synovial sarcoma. He received chemotherapy, then surgery that removed the left lung with the pleura. This was also a complete removal, with a good response to chemotherapy in the tissue. However, a biopsy-proven recurrence on the chest wall appeared 6 months after surgery. The authors concluded that chemotherapy followed by extensive surgery is a feasible strategy for these tumors, with strict follow-up.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of two patients (case report)
• Who was studied: Two patients treated at University Hospitals Leuven, Belgium: a 37-year-old white woman with a primary pleural yolk sac tumor and a 26-year-old man with a primary pleural synovial sarcoma
• Exposure: Not reported. The article does not mention asbestos or any occupational exposure. It studied treatment (chemotherapy, extensive surgery, and in the first case heated intrathoracic chemotherapy).
• Main results:
  • Yolk sac tumor patient: complete (R0) resection of a hepatoid type pleural yolk sac tumor
  • Yolk sac tumor patient: tissue analysis showed very little response to the chemotherapy given before surgery, with extensive residual disease
  • Yolk sac tumor patient: discharged from hospital on postoperative day 26
  • Yolk sac tumor patient: a PET-CT scan after surgery showed no signs of recurrence, and serum alpha-fetoprotein fell to a minimum of 18 µg/l
  • Synovial sarcoma patient: complete (R0) resection by extrapleural pneumonectomy
  • Synovial sarcoma patient: tissue examination showed a good response to chemotherapy, with only limited viable residual tumor
  • Synovial sarcoma patient: estimated viable tumor load after chemotherapy was around 2 to 3%
  • Synovial sarcoma patient: uneventful recovery after surgery
  • Synovial sarcoma patient: early recurrence on the chest wall, proven by biopsy, on scans 6 months after surgery
• The authors' conclusion: The authors concluded that chemotherapy before surgery (with or without heated intrathoracic chemotherapy), followed by extensive surgical resection, is a feasible strategy for non-mesothelioma primary pleural tumors, and that strict follow-up is crucial because of the high risk of recurrence
• Limitations the authors state:
  • Parts of the treatment protocols were novel, and evidence on how well certain treatment choices work is limited
  • The results could not be compared with other cases, because this was described as the first published pleural yolk sac tumor case
  • Repeated chemotherapy and extensive surgery affected both patients' physical condition, requiring intense rehabilitation and long recovery

Topics

Medical terms in this study, explained in our Lexicon: Surgical Resection, Neoplasm, Synovial Sarcoma, Metastasis, Mesothelioma, Neoadjuvant Therapy, Intrathoracic, Chemotherapy.

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