Cardiac synovial sarcoma masquerading as effusive constrictive pericarditis.

Area of Science:

• Cardiovascular Pathology
• Oncology
• Rare Tumors

Background:

• Primary cardiac synovial sarcoma is exceptionally rare, typically affecting middle-aged males.
• It originates from the pericardium or heart chambers, often presenting insidiously.

Observation:

• A 22-year-old female presented with dyspnea, palpitations, and chest pain.
• Initial imaging suggested a cystic pericardial mass with effusion, mimicking an infected pericardial cyst.
• Surgical exploration revealed an adherent malignant spindle cell tumor.

Findings:

• Histopathology and immunohistochemistry confirmed a Transducin-like enhancer of split 1 (TLE 1)-positive synovial sarcoma.
• The tumor presented atypically, masquerading as effusive constrictive pericarditis.
• Preoperative diagnosis was challenging due to the tumor's presentation.

Implications:

• This case highlights the importance of considering rare cardiac tumors in young patients with pericardial effusions.
• Synovial sarcoma can present with atypical features, necessitating thorough diagnostic evaluation.
• Adjuvant chemo-radiation therapy is a potential treatment modality for resected cardiac synovial sarcoma.