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Synovial sarcoma occurring in the pleura and lung is extremely rare. We report a case of pleuropulmonary synovial sarcoma as a second malignant neoplasm. The patient had been diagnosed with acute myelomonocytic leukemia at 5 years of age, and received matched sibling donor allogeneic bone marrow transplantation, with total body irradiation and cyclophosphamide conditioning. At 22 years of age, he complained of worsening chest discomfort and exertional dyspnea. Chest CT revealed a huge mass in the right middle lobe, pleura, and diaphragm. The patient was initially diagnosed as sarcomatoid malignant mesothelioma, without any environmental or occupational asbestos exposure. Five months later, the patient presented with soft tissue metastasis and underwent needle biopsy. Pathological examination including SYT-SSX RT-PCR revealed synovial sarcoma, which led to a review of the original tumor findings and confirmed the diagnosis of pleuropulmonary synovial sarcoma. To the best of our knowledge, our patient is the first case of pleuropulmonary synovial sarcoma developed after allogeneic hematopoietic stem cell transplantation.

Childhood acute leukemia has achieved tremendous treatment outcome improvement over the past several decades. Given that pediatric leukemia remains the most common type of childhood malignant tumors, there are still unmet needs in relapsed/refractory diseases. Moreover, reducing the toxic adverse effects of chemotherapy is another big challenge. Over the past decades, immunotherapy in pediatric leukemia has achieved significant improvement. This review will focus on the recent development and achievement of bi-specific T-cell engagers, antibody-drug conjugates, and chimeric antigen receptor T cell therapies in pediatric leukemia. Moreover, several prevalent obstacles in administering these treatments will also be discussed. Based on the characteristics of each treatment, a variety of clinical trials are currently underway. As a new treatment modality, immunotherapy should be optimally applied based on disease conditions.