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Kumar S, Rahul K, Tewarson V, Kumar B, Hakim MZ, Kumar S, Singh SK. Cardiac synovial sarcoma masquerading as effusive constrictive pericarditis. Indian J Thorac Cardiovasc Surg 2023; 39:300-304. [PMID: 37124594 PMCID: PMC10140245 DOI: 10.1007/s12055-022-01461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023] Open
Abstract
Primary cardiac synovial sarcoma is a rare entity, arising from the pericardium or the chambers of the heart. It presents in the 4th decade of life with a striking male predisposition. We describe an unusual case of a 22-year-old female who presented with complaints of dyspnoea on exertion, palpitations, and chest pain. Trans-thoracic echocardiography was suggestive of a cystic pericardial mass with pericardial effusion anterior and lateral to the right ventricle. Computed tomography scan (CT scan) revealed thick-walled predominantly cystic lesion over the left ventricle with gross pericardial effusion with internal septations. These findings were suggestive of an infected pericardial cyst. Upon surgery, an adherent mass in the pericardial cavity was found which was not separable from the right heart structures, the great vessels, and the left ventricle. Biopsy was taken, histopathology was suggestive of spindle cell neoplasm, and an immunohistochemistry analysis revealed Transducin-like enhancer of split 1 (TLE 1)-positive malignant spindle cell tumour likely synovial sarcoma. After surgery, the patient received serial adjuvant chemo-radiation therapy. The synovial sarcoma masqueraded as effusive constrictive pericarditis, due to which it eluded preoperative diagnosis.
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Affiliation(s)
- Sarvesh Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Kumar Rahul
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Vivek Tewarson
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Bhupendra Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Mohammad Zeeshan Hakim
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Shobhit Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
| | - Sushil K. Singh
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Shahmina Road, Lucknow, 226003 India
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2
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Urbini M, Astolfi A, Indio V, Nannini M, Pizzi C, Paolisso P, Tarantino G, Pantaleo MA, Saponara M. Genetic aberrations and molecular biology of cardiac sarcoma. Ther Adv Med Oncol 2020; 12:1758835920918492. [PMID: 32489430 PMCID: PMC7238448 DOI: 10.1177/1758835920918492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 03/19/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiac tumors are rare and complex entities. Early assessment and differentiation between non-neoplastic and neoplastic masses, be they benign or malignant, is essential for guiding diagnosis, determining prognosis, and planning therapy. Cardiac sarcomas represent the most frequent primary malignant histotype. They could have manifold presentations so that the diagnosis is often belated. Moreover, considering their rarity and the limitation due to the cardiac location itself, the optimal multimodal management of patients affected by primary cardiac sarcomas still remains highly difficult and outcome dismal. Therefore, there is an urgent need to improve these results mainly focusing on more adequate tools for prompt diagnosis and exploring new and more effective therapies. Knowledge about the molecular landscape and pathogenesis of cardiac sarcoma is even more limited due to the rarity of this disease. In this sense, the molecular characterization of heart tumors could unfold potentially novel, druggable targets. In this review, we focused on genetic aberrations and molecular biology of cardiac sarcomas, collecting the scarce information available and resuming all the molecular findings discovered in each tumor subtype, with the aim to get further insights on mechanisms involved in tumor growth and to possibly highlight specific molecular profiles that can be used as diagnostic tests and unveil new clinically actionable targets in this tricky and challenging disease.
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Affiliation(s)
- Milena Urbini
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Valentina Indio
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Department of Specialized, Experimental and
Diagnostic Medicine, Cardiology and Transplantation, Sant’Orsola-Malpighi
Hospital, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Department of Specialized, Experimental and
Diagnostic Medicine, Cardiology and Transplantation, Sant’Orsola-Malpighi
Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
| | - Maria Abbondanza Pantaleo
- “Giorgio Prodi” Cancer Research Center,
University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Bologna, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and
Diagnostic Medicine, Medical Oncology Unit, Sant’Orsola-Malpighi Hospital,
University of Bologna, Via Massarenti, 9, Bologna, Bologna 40138,
Italy
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Salvador-Coloma C, Saigí M, Díaz-Beveridge R, Penín RM, Pané-Foix M, Mayordomo E, Melián M, Schuler M, García Del Muro X, Font de Mora J. Identification Of Actionable Genetic Targets In Primary Cardiac Sarcomas. Onco Targets Ther 2019; 12:9265-9275. [PMID: 31807008 PMCID: PMC6847994 DOI: 10.2147/ott.s214319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary cardiac tumors are extremely rare; most are myxomas with a benign prognosis. However, primary sarcomas are highly aggressive and treatment options are limited. Radical surgery is often not feasible and conventional therapies provide only modest results. Due to the rare nature of primary cardiac tumors, there are no proper randomized studies to guide treatment. Their complexity requires alternative approaches in order to improve treatment efficacy. METHODS We isolated DNA from 5 primary cardiac sarcomas; the quality of DNA from 3 of them was sufficient to perform high-resolution single nucleotide polymorphism (SNP) array analysis. RESULTS In the present study, molecular karyotyping revealed numerous segmental chromosomal alterations and amplifications affecting actionable genes that may be involved in disease initiation and/or progression. These include chromosomal break flanking AKT2 in undifferentiated pleomorphic rhabdomyosarcoma, chromosomal break in promoter of TERT, and gain of CDK4 and amplification of MDM2 in inflammatory myofibroblastic tumor. We detected segmental break flanking MOS in high-grade myxofibrosarcoma. In addition, the high number of chromosomal aberrations in high-grade myxofibrosarcoma may cause multiple tumor-specific epitopes, supporting the study of immunotherapy treatment in this type of aggressive tumor. CONCLUSION Our results provide a genetic rationale that supports an alternative, personalized therapeutic management of primary cardiac sarcomas.
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Affiliation(s)
- Carmen Salvador-Coloma
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Laboratory of Cellular and Molecular Biology, Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María Saigí
- Department of Medical Oncology, Institut Català Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roberto Díaz-Beveridge
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosa María Penín
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - María Pané-Foix
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Empar Mayordomo
- Department of Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marcos Melián
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mona Schuler
- Department of Cardiac Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Xavier García Del Muro
- Department of Medical Oncology, Institut Català Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaime Font de Mora
- Laboratory of Cellular and Molecular Biology, Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Liu C, Windsor M, Wall D, Natani S, Holewa Z. Complete excision of large pericardial synovial sarcoma. ANZ J Surg 2019; 90:1180-1182. [PMID: 31566284 DOI: 10.1111/ans.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/13/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Chang Liu
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Morgan Windsor
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Douglas Wall
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sarvesh Natani
- Department of Anaesthetics, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Zoe Holewa
- Department of Anatomical Pathology, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Duran-Moreno J, Kampoli K, Kapetanakis EI, Mademli M, Koufopoulos N, Foukas PG, Kostopanagiotou K, Tomos P, Koumarianou A. Pericardial Synovial Sarcoma: Case Report, Literature Review and Pooled Analysis. In Vivo 2019; 33:1531-1538. [PMID: 31471401 PMCID: PMC6754991 DOI: 10.21873/invivo.11633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pericardial synovial sarcomas (PSS) are very rare tumors, with dismal prognosis and limited data. We describe the clinical features and identify prognostic factors of primary PSS. CASE REPORT We describe the case of a 56-year-old male patient with PSS managed by the multidisciplinary team of thoracic oncology. The therapeutic plan comprised surgery, chemotherapy, stereotactic radiosurgery and targeted therapy, with excellent results. MATERIALS AND METHODS Data from 37 cases reported in English during the past 20 years were gathered and analyzed. PSS was found to occur at a mean age of 36±17.082 (range=13-67) years. Survival analysis was performed on 20 cases with follow-up of at least 6 months. CONCLUSION Only complete resection of the tumor seems to be an independent prognostic factor. To our knowledge, this is the first report on the safety and effectivity of pazopanib in PSS and may provide guidance for similar cases in the future.
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Affiliation(s)
- Jose Duran-Moreno
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Kampoli
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Mademli
- Second Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Koufopoulos
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis G Foukas
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Kostopanagiotou
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Hoey ETD, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quant Imaging Med Surg 2014; 4:489-97. [PMID: 25525582 DOI: 10.3978/j.issn.2223-4292.2014.11.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 12/19/2022]
Abstract
Cardiac magnetic resonance imaging (MRI) is the reference standard technique for assessment and characterization of a suspected cardiac tumour. It provides an unrestricted field of view, high temporal resolution and non-invasive tissue characterization based on multi-parametric assessment of the chemical micro-environment. Sarcomas account for around 95% of all primary malignant cardiac tumours with lymphoma, and primary pericardial mesothelioma making up most of the remainder of cases. By contrast cardiac metastases are much more common. In this article we review the MRI features of the spectrum of histologically malignant cardiac and pericardial tumours as well as some potential tumour mimics.
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Affiliation(s)
- Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Muhammad Shahid
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Shobhit Baijal
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Helen Simpson
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
| | - Richard W Watkin
- 1 Department of Radiology, 2 Department of Cardiology, 3 Department of Oncology, Heart of England NHS Trust, Birmingham, UK
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Phatak P, Khanagavi J, Aronow WS, Puri S, Yusuf Y, Puccio C. Pericardial synovial sarcoma: challenges in diagnosis and management. F1000Res 2014; 3:15. [PMID: 24715974 PMCID: PMC3954165 DOI: 10.12688/f1000research.3-15.v2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction: Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. Case: A 27-year-old man presented with dyspnea and cough of three weeks duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the tumor to be a monophasic synovial sarcoma. Fluorescent in-situ hybridization (FISH) was positive for SS18 (SYT) gene rearrangement on chromosome 18q11, substantiating the diagnosis. Work-up for metastases was negative. Neo-adjuvant chemotherapy with high dose ifosfamide led to substantial reduction in the size of the tumor. The patient underwent surgical resection and external beam radiation therapy (EBRT) post surgery. He had symptom-free survival for 8 months prior to local recurrence. This was managed with left lung upper lobectomy and follow-up chemotherapy with docetaxel. The patient is currently stable with an acceptable functional status. Conclusion: In patients with pericardial effusions of unknown etiology, multiple modalities of cardiac imaging must be employed if there is suspicion of a pericardial mass. CT and magnetic resonance imaging (MRI) are useful to evaluate for pericardial thickening or masses in addition to TTE. Treatment of synovial sarcoma is not well established. Surgery is the cornerstone of treatment. In non-resectable tumors, aggressive neo-adjuvant chemotherapy with ifosfamide followed by surgical resection and EBRT may lead to improved outcome.
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Affiliation(s)
- Prajakta Phatak
- Department of Medicine, Westchester Medical Center / New York Medical College, Valhalla, NY 10595, USA
| | - Jagadish Khanagavi
- Department of Medicine, Westchester Medical Center / New York Medical College, Valhalla, NY 10595, USA
| | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center/ New York Medical College, Valhalla, NY 10595, USA
| | - Sonam Puri
- Department of Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Yasmin Yusuf
- Department of Pathology, Westchester Medical Center / New York Medical College, Valhalla, NY 10595, USA
| | - Carmelo Puccio
- Division of Oncology, Westchester Medical Center/ New York Medical College, Valhalla, NY 10595, USA
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Pericardial synovial sarcoma: a case report and review of the literature. Surg Today 2013; 44:2167-73. [DOI: 10.1007/s00595-013-0720-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/14/2013] [Indexed: 02/07/2023]
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9
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Wang JG, Li NN. Primary cardiac synovial sarcoma. Ann Thorac Surg 2013; 95:2202-9. [PMID: 23647858 DOI: 10.1016/j.athoracsur.2013.01.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/10/2013] [Accepted: 01/18/2013] [Indexed: 11/27/2022]
Abstract
Primary cardiac synovial sarcoma is an extremely rare entity. The clinical and pathologic characteristics are still poorly understood, and prognostic factors influencing overall survival are still unknown. In the present study, all characteristics of reported patients, including sex, age, clinical presentations, laboratory tests, electrocardiogram, imaging findings, pathology, location, therapy, and follow-up were carefully reviewed and survival analysis was performed. The present study has summarized some key features and may provide an effective consultation for the diagnosis and treatment of the tumor.
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Affiliation(s)
- Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
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Lin YJ, Yang QX, Tian XY, Li B, Li Z. Unusual primary intracranial dural-based poorly differentiated synovial sarcoma with t(X; 18)(p11; q11). Neuropathology 2012; 33:75-82. [DOI: 10.1111/j.1440-1789.2012.01320.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Etschmann B, Krombach G, Böning A, Gattenlöhner S. Pleomorphic high-grade sarcoma of the heart mimicking cardiac myxoma. BMJ Case Rep 2012; 2012:bcr.12.2011.5277. [PMID: 22605601 DOI: 10.1136/bcr.12.2011.5277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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