 Good morning everyone. I am Dr. Sumedha Ghoshal, a second-year PG resident in the Department of Radiogenesis of Analyst Medical College and Hospital. My title for paper presentation is a case report on primary pulmonary synovial sarcoma. Case discussion. A 41-year-old female presented with a dry cough for seven months, progressively increasing shortness of breath and right side of pleuritic chest for two months. There was no history of hemoptysis, no history of past exposure to asbestos, no recent cold or sore throat or fever or any allergic triggers. On examination of the respiratory system, respiratory rate was found out to be 25 breaths per minute with a spio2 of 98%. On inspection, there was decreased movement of right hemothorax, dilapidation showed decreased vocal cremitis, auscultation showed decreased vesicular blood sounds and decreased vocal resonance on the right side with dull note on percussion on the right side. Examination of other systems were within normal limits. A subsequently, a chest x-ray was performed which showed a smooth, well-defined, homogeneous opacity noted occupying the middle and lower zones of the right plaque. There was no mediestinal shifting present, the left lung appeared normal, vertebra rips and other bones and soft tissues appeared normal. A contrast-enhanced CT scan was performed which showed a large, well-defined, well-marginated, heterogeneously enhancing right lung mass with definite pleural extension was present and internal cystic and necrotic areas were present. In the next slide, we can see the definite pleural extension of the mass and in this slide, we can see the progressive compression of the right main bronchus by the mass. An ultrasonic was performed and a well-defined hypoechoic heterogeneous sol was noted in the right lung with internal cystic necrotic areas. On the color Doppler, the solid components of the mass were taking rascality. An MRI was performed and in this MRI in the sagittal and the axial G2 wedged image, it shows a heterogeneously hyper intense multi-lubbulated lesion in the right lung. The hyper intense areas on T2 correspond to cystic, hemorrhagic, necrotic areas or necrotic areas containing mix or material. An axial T1 scan shows a well-defined multi-lubbulated lesion with heterogeneous intermediate signal. Intermediate signal means the signal intensity corresponds to the signal intensity of the parietal muscle layer. Along with that, there were internal hypoechoic areas, probably hemorrhagic areas noted in the right lung. This was a coronal T2 and the axial T2 wedged image which was showing definite invasion of the tumor into the parietal muscular layer. We can see the ribs are definitely involved along with the parietal muscle layers. Acetic iodide truchar biopse was performed from the lung cell which ribbons sheets of spindle cells with vesicular nuclei, nuclear overlapping, scantycytoplasm and atypical mitosis. Occasionally gland-like epithelial architecture was also noted. Features were highly suggestive of cyanoblast sarcoma biocasic variant with cystic change. However, other possibilities of other high-grade sarcomas like carcinosarcoma, fibrosarcoma, PNSTs cannot be excluded. Subsequent and immunohistochemistry was performed and on immunohistochemistry, the cells were positive for TLE-1, BCL-2, CD-99 and focally positive for cytokeratin and epithelial membrane antigen, negative for S-100, carotidinase, stat-6 and cyanoptoficin. The image above shows the positively BCL-2 staining of the spindle cells. Based on the histopathological examination and the immunohistochemistry or diagnosis of PPSS that is primary pulmonary, plenopulmonary cyanoblast sarcoma biocasic variant was made. Further imaging with PET scan and MRI of the brain was performed to note for any metastatic lesions. The patient was then put under doxorubicin-based chemotherapeutic regimen which consisted of cytoplasm and doxorubicin, dacarbazin, vincristin and PET GCSF chemoregimen. Case discussion. Primary pulmonary cyanoblast sarcomas are extremely rare neoplasm. It consists of only 0.1 to 0.5% of all lung neoplasms. The diagnosis is made only after metastatic sarcomas from other soft tissues of the body and other primary parankimer sarcomas like maniplin, fibrosystrocytoma, leomarsarcoma, fibrosarcoma, hematurpericytoma and sarcomatite carcinomas have been rolled out. It chiefly affects the young and middle-aged population with equal sex privilege. PPSS can metastasize to the bone, liver, skin, CNS and even the breast tissue. It has four subtypes, the monophysic fibros variant, the monophysic epithelium, biophysic holy-dependent shift. Out of this the monophysic subtypes was the most common. Our case was a case of biophysic variant. Cytogenic study with reverse transcriptive PCR helps to differentiate monophysic and biophysic forms. Cynogen sarcoma is characterized by reciprocal chromosome 1 translocation between chromosome X and chromosome 80, P11.2 and Q11.2 gene focuses, which results from fusion of S5T gene on chromosome 80 to either of the two genes SSXX and SSX2 on chromosome X. S5T SSX1 gene is associated with biophysic subtype and prognosis is bad, whereas the monophysic subtype may have either of the following two transfusion transcripts, S5T SSX1 or S5T SSX2. On tumors with S5T SSX2 gene shows monophysic morphology. The prognosis of PPSS is very poor with a overall 5-year survival rate of only 50%. Conclusion So primary pulmonary synoval sarcoma is an extremely rare and aggressive tumor. Dynasties require the combination of radiology, pathology, immunohistochemistry and cytological analysis. It has been found out that the treatment is a multimodal approach which includes resection. If the tumors are very large, then chemotherapy and radiotherapy is performed. Though the role of radiotherapy is not well established, but PPSS is highly chemo sensitive to hyperschromite and doxobacin based chemo regimen. These were my references. Thank you for patient hearing.